The cognitive and socio-demographic influences on driving performance and driving cessation in post-stroke drivers

Background: Driving is a complex activity requiring highly integrated cognitive and perceptual functions that can be negatively affected following a stroke. The decision to continue or cease with driving after a stroke may not be exclusively dependent on deficits in cognitive and motor abilities. Instead, it is possible that social supports, alternative means of transportation, education level, income, self-regulation ability and the awareness of personal health problems may also influence the decision. Aim: The aim of this research was to explore the influence of personal and socioeconomic factors, in addition to existing cognitive impairment, on the decision of post-stroke adults to return to driving. Method: A case control design was employed to compare driving performance of 48 individuals who had experienced a stroke and 22 volunteer healthy control participants. Half of the post-stroke cohort (N=24) had continued driving and the other half had ceased driving. Socio-demographic and driving-related cognitive performance data were collected to characterise the comparison groups before driving performance was assessed in a driving simulator. Results: Overall, the post-stroke groups did not perform as well as the control participants in the cognitive and driving assessments. The perceived ability to drive after a stroke was not significantly correlated with participants’ actual driving ability. Post-stroke adults were more likely to continue driving if they reported having a tertiary level education and a greater income. Conclusion: The decision to return to driving after a stroke is a complicated, multifactorial process. This study confirms previous research, which found that cognition and driving performance are impaired post-stroke. The findings also suggest that post-stroke drivers’ decision to return to driving was not linked to their ability to drive, but more to socio-demographic and environmental factors. Further screening tools and assessments to identify those at risk when returning to the road post-stroke are required.