Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
BMC Geriatr. 2020 Jul 11;20(1):241. doi: 10.1186/s12877-020-01637-1.
No papers have examined the relationship between socio-demographic characteristics and cognitive performance in oldest old subjects (i.e, > = 80 years old) asking for driving license renewal. We hypothesize that, even in this highly functioning population, age, sex, and education influence cognitive performance, expressed as total or single domain (raw) test scores. This research question allows to describe, identify, and preserve independence of subjects still able to drive safely.
We examined cross-sectionally a cohort of > = 80 years old subjects (at enrollment) asking for driving license renewal in the Milan area, Italy, 2011-2017. The analysis was restricted to 3378 first and 863 second visits where individual's cognitive performance was evaluated. According to the study protocol, the Mini Mental State Examination (MMSE) test was administered at the first visit for driving license renewal and the Montreal Cognitive Assessment (MoCA) test at the second visit, following an additional renewal request. Ordinary least squares regression models were fitted at either time points. In each model, we included age, sex, and education as independent variables, whereas the dependent variable was total or single domain score for either test. In total, we fitted 15 regression models to assess our research hypothesis.
The median subject in our sample reached the maximum scores on domains targeting operational and tactical abilities implied in safe driving, but had sub-optimal scores in the long-term memory domain included among the strategic abilities. In multiple models, being > = 87 (versus 80- < 86 years old) significantly decreased the mean total and memory scores of MMSE, but not those of the MoCA. Females (versus males) had significantly higher mean total and long-term memory scores of either tests, but not other domains. Mean total and single domain scores increased for increasing education levels for either tests, with increments for high school graduates being ~ 2 of those with (at most) a junior high school diploma.
Sex and education, as well as age to a lesser extent, predict cognitive functioning in our oldest old population, thus confirming that concepts like cognitive reserve and successful ageing are valuable constructs in the identification of older subjects still able to drive.
目前尚无文献研究社会人口统计学特征与要求更新驾驶执照的高龄（即≥80 岁）人群认知表现之间的关系。我们假设，即使在这个功能高度健全的人群中，年龄、性别和教育程度也会影响认知表现，表现为总测试或单个领域（原始）测试分数。该研究问题可以描述、识别并维持仍能安全驾驶的人群的独立性。
我们横断研究了 2011 年至 2017 年期间，意大利米兰地区要求更新驾驶执照的≥80 岁人群（入组时）队列。分析仅限于首次就诊时进行驾驶执照更新评估认知表现的 3378 次就诊和 863 次后续就诊。根据研究方案，首次就诊时进行简易精神状态检查（MMSE）测试，随后在再次更新申请时进行蒙特利尔认知评估（MoCA）测试。在两个时间点都拟合了普通最小二乘回归模型。在每个模型中，我们将年龄、性别和教育程度作为自变量，而总测试或单个领域分数作为因变量。总共拟合了 15 个回归模型来评估我们的研究假设。
在我们的样本中，中位数受试者在涉及安全驾驶的操作和战术能力的目标领域达到了最高分，但在包括战略能力在内的长期记忆领域的分数较低。在多个模型中，年龄≥87 岁（与 80-＜86 岁相比）显著降低了 MMSE 的总评分和记忆评分，但 MoCA 则不然。女性（与男性相比）的总评分和任何测试的长期记忆评分都显著较高，但其他领域则不然。对于任何测试，教育程度越高，总评分和单个领域评分越高，高中毕业生的增量约为初中及以下学历者的两倍。
性别和教育程度，以及年龄在较小程度上，预测了我们的高龄人群的认知功能，这证实了认知储备和成功老龄化等概念在识别仍能驾驶的老年人群方面是有价值的。
