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Key Research Findings

2014 – 2018

  1. Cataract surgery and intraocular lens implantation reduces the rate of crash involvement by 50% among older drivers, as compared to those with cataract who do not elect surgery. More recently it has been determined that earlier cataract surgery would reduce crashes at the societal level.
  2. Older adults with slowed visual processing speed as measured by UFOV® take longer to complete visual tasks typical of everyday life compared to those with faster processing speeds.
  3. Older adults with cataract that causes vision impairment, in particular those who decline cataract surgery, have an increased risk of death.
  4. Speed of processing training improves driving competence in older adults.
  5. An educational program designed for high-risk, visually impaired older drivers does not improve driving safety.
  6. Older drivers who exhibit driving errors tend to have higher impulsivity.
  7. Older veterans reported less difficulty and more confidence in their mobility-related activities following a residential blind rehabilitation training program, as compared to before they entered the program.
  8. Slowed visual processing speed on a divided attention task (UFOV®) in older adults is associated with impaired scores on a performance-based mobility assessment.
  9. A cumulative meta-analysis revealed a large and consistent relationship between poor UFOV® performance and poor driving outcomes.
  10. Cognitive function sometimes improves after cataract surgery but cannot be attributed to the surgery itself or to improved visual function.
  11. We have developed a valid and reliable questionnaire for assessing night vision problems and problems seeing under reduced illumination (including mobility tasks) for older adults.
  12. A population-based study of older drivers conducted in the Maryland Motor Vehicle Administration demonstrated the feasibility of conducting brief assessments of risk in a field setting. Further, the study highlights the importance of measuring cognition as well as vision.
  13. Among older adults screened by the Maryland Motor Vehicle Administration, those with poorer cognitive function were twice as likely to incur an at-fault motor vehicle crash.
  14. Home based speed of processing training was found to be nearly as effective as that administered by a trainer in improving cognitive and everyday function.
  15. We have developed a vision-targeted health-related quality of life questionnaire for use in nursing home residents, which is valid, reliable and responsive to intervention.
  16. Compared to older adults without MCI, older participants with amnestic MCI, non-amnestic MCI, and multi­ domain MCI showed faster rates of decline in everyday functioning over a three-year period.
  17. Vision impairment rates in the nursing home are much higher than among community-dwelling older adults; refractive error correction and cataract surgery in nursing home residents reduces depressive symptoms and improves health-related quality of life.
  18. Evaluation of Florida’s new vision re-screening law for 80 year old drivers indicated that re-screening is not a deterrent to older adults seeking license renewal. Furthermore, only a small percentage of those seeking renewal failed the visual acuity screening test and were denied licensure.
  19. In 1,656 older adults across a 5-year period, speed of processing, older age, congestive heart failure, and poorer physical performance were significant risk factors for driving cessation.
  20. Health-related quality of life benefits occurred among nursing home residents following interventions to improve vision regardless of the presence of cognitive impairment as low as MMSE of 13.
  21. Vision-enhancing interventions in nursing home residents (glasses and cataract surgery) did not have any observable short-term impact on physical or cognitive function.
  22. Some adults with hemianopia and quadrantanopia due to stroke or other brain injuries are capable of safe driving performance measured by on-road assessment.
  23. Using a case-control design, persons with MCI were as accurate in completing timed Instrumental Activities of Daily Living as controls, but MCI participants took significantly longer to complete the tasks, suggesting that slowed IADL performance may be an early marker of functional decline in MCl.
  24. Individuals with MCI were equivalent to controls in UFOV® assessment of simple attention but had significantly lower processing speed on UFOV® tasks of divided and selective attention, with divided attention tasks providing greatest discrimination of MCI from cognitively normal participants.
  25. In on-road assessments, persons with MCI were assigned lower ratings of global driving competence than controls by a certified driving rehabilitation specialist masked to participants’ MCI status, as well as lower ratings of left turn and lane control maneuvers.
  26. Cognitive speed of processing is key to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation.
  27. Older drivers with cognitive speed of processing difficulties who completed speed of processing training were 40% less likely to cease driving over the subsequent 3 years.
  28. Driving cessation is accompanied by significant declines in physical and social functioning, physical performance, and physical role.
  29. Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers.
  30. Among community-dwelling older adults, older age, health, poor near visual acuity, depressive symptoms, compromised cognitive status, and being a nondriver are associated with increased risk for a 3-year mortality. Non-drivers were four to six times more likely to die than drivers during the subsequent 3-year period.
  31. The deleterious, impact of vision impairment on HRQoL in nursing home residents was not exacerbated by the co-occurrence of cognitive impairment. Aging-related visual impairment in nursing home residents is often reversible through treatment leading to improved HRQoL, and thus it is clinically important to know that cognitive impairment is unlikely to interfere with this benefit.
  32. Self-regulation among older drivers at-risk for crashes is an insufficient compensatory approach to eliminating increased crash risk.
  33. The MOS 2.0 assessment for vision in nursing home residents is positively associated with visual acuity and contrast sensitivity but is insensitive to vision impairment and degrees of impairment. The validity of the MOS 2.0 as a mechanism for triggering comprehensive eye care for nursing home residents is questionable.
  34. Cognitive training that targets reasoning and speed of processing can improve the cognitive-specific sense of personal control over one’s life in older adults.
  35. The speed-of-processing intervention reduced the risk of clinically important increases in depressive symptoms at 1- and 5-years post baseline.
  36. Relative to controls, cognitive speed of processing and reasoning training transferred to decreased at-fault MVC rate among older drivers. Considering the importance of driving mobility, the costs of crashes, and the benefits of cognitive training, these interventions have great potential to sustain independence and quality of life of older adults.
  37. In analyses of 5-year trajectories of mobility change in older adults (N = 2,355) with psychometrically defined MCI participants with possible MCI showed reduced baseline mobility for all outcomes as well as faster rates of decline for driving frequency and difficulty.
  38. The speed of processing intervention significantly protected self-rated health in ACTIVE.
  39. The UFOV® test was given to a sample of drivers 75+ years across the state of Alabama (N=2235) as a means of attaining a reduction in insurance rates if successful on the test. Participants who failed the assessment were 1.65 times more likely to have an at-fault crash and 1.66 times more likely to have an at­ fault insurance claim in the previous five years as compared to participants who passed the assessment. Prospectively, these same participants were 1.85 times more likely to have an at-fault crash and 2.73 times more likely to have an at-fault claim in the subsequent 1.29 years after assessment as compared to participants who passed the assessment.
  40. Neighborhood socioeconomic position (SEP) was found to predict crystallized cognitive abilities (specifically, vocabulary) but not fluid abilities, suggesting that neighborhood effects may be related to sociocultural influences on cognitive development. There was no association between neighborhood SEP change immediately following cognitive training.
  41. A systematic but brief exposure to cognitive training in late life did not reduce the likelihood of developing dementia over 5 years. However, given the protective direction of the hazard ratio and power limitations for detecting small but significant effects, risk reduction due to training is possible. The investigation of primary prevention programs for dementia, including ones focused on cognitive interventions, should be a national research priority.
  42. Adults with HIV are at risk for deficits in speed of processing that can interfere with performing instrumental activities of daily living. This study demonstrated that speed of processing training improved cognitive functioning and has potential to improve everyday functioning in the growing population of adults aging with HIV.
  43. Initial cognitive training effects in the ACTIVE randomized controlled trial were maintained over 5 years and amplified by booster sessions. A single booster session counteracted 4.92 months of age-related processing speed decline. Cognitive performance improved by 2.5 standard deviations for participants who attended all 10 initial sessions and all 8 booster sessions compared to randomized participants who attended none.
  44. Among persons with clinical MCI, lower hippocampal volume assessed with structural MRI predicted lower on-road driving performance in the specific domain of lane control, suggesting that an accessible neuroimaging approach can serve as a marker of disease severity that might signal risk of driving skills decline.
  45. Older adult participants were randomized to receive practice with an action game (Medal of Honor), a placebo control arcade game (Tetris), a clinically validated UFOV® training program, or into a no contact control group. The UFOV® training improved selective attention significantly more than the game groups; all three intervention groups improved significantly more than no-contact controls..
  46. This study examined indicators of childhood educational quality as predictors of cognitive performance and decline in later life. Drawing from archival records, higher student – teacher ratio was associated with worse cognitive function and greater school year length was associated with better cognitive function after adjustment for education level, age, race, gender, income, reading ability, vascular risk factors, and health behaviors. Educational factors other than years of schooling may influence cognitive performance in later life.
  47. A proactive policy encouraging cataract surgery earlier for a lesser level of complaint might significantly reduce MVCs among older drivers. Our model found a net effect on total cost – all MVC costs plus cataract surgery expenditures – is a reduction of about 16%. A policy of early surgery would significantly reduce MVCs and their associated cost.
  48. Being a nondriver may increase mortality risk by exacerbating already-declining health and physical performance. For non-drivers from large cities, health and physical performance account for the relationship between driving cessation and mortality. However, for non-drivers from small cities with fewer alternative transportation options, there appears to be a direct link between driving cessation and mortality that cannot be explained by health.
  49. This population-based examination of the· prevalence of vision impairment and major ophthalmological conditions among drivers aged 70 and older found that serious impairment in central vision-visual acuity or contrast sensitivity is rather uncommon; however, slowed visual processing speed is common.
  50. This study developed a vision-targeted health-related quality of life (HRQOL) measure for the NIH Toolbox for the Assessment of Neurological and Behavioral Function.
  51. Using driving simulation, we demonstrated that more lane deviations and crashes occurred during texting. No significant differences were detected between age groups, suggesting that all drivers, regardless of age, may drive in a manner that impacts safety and traffic flow negatively when distracted.
  52. Results of this study suggest that individuals with HIV are at risk for poorer neuropsychological and everyday functioning than their HIV-uninfected counterparts, and that neuropsychological functioning is related to everyday functioning irrespective of age.
  53. This study did not find unique cognitive subtypes in HIV, but rather a subset of individuals who exhibit globally normal performance and those with below average performance.
  54. The method of loci (Mol) is a complex visuospatial mnemonic strategy but may be too attentionally demanding. We evaluated the hypotheses that training can increase the use of Mol, and that Mol use is associated with better memory, using data from the ACTIVE study. Findings suggest that after training, the Mol is used by up to 25% of older adults, and that its use is associated with both immediate and sustained memory improvement.
  55. Falling two or more times in the previous year may be associated with at-fault MVC involvement, especially in white drivers. This finding has practical and clinical relevance for those caring for older adults. History of frequent falling can be used to identify individuals at risk of MVC involvement but also to begin a dialogue about driver safety.
  56. This study found that longitudinal declines in fluid cognition are associated with reduced comprehension of spoken language. Preserved verbal ability may not protect against developmental declines in memory for speech.
  57. Each ACTIVE cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.
  58. SOP training delays the onset of Alzheimer’s Disease.