Impact of post-stroke cognitive dysfunction on driving ability

Abstract

The paper aims to present the current views on the impact of post-stroke cognitive deficits on driving ability, and diagnostic assessment practices in this area. Firstly, the neuropsychological consequences of stroke are briefly presented. This part focuses specifically on visuospatial and executive dysfunctions. Among those dysfunctions, unilateral neglect, especially as it is frequently associated with anosognosia, may have the greatest impact on driving ability, leading to an increased accident risk. Then, different approaches to assessing fitness to drive after stroke are presented, including on-road testing, testing with the use of simulator, and clinical assessment focusing on cognition. The role of cognitive assessment in predicting fitness to drive is described in more detail. The Clock Drawing Test is the most appropriate screening measure in this context, as it engages both visuospatial and executive functions. The Trail Making Test is the most popular working memory test in the context of drivers’ assessment, as it requires visual search and psychomotor speed. The Rey Complex Figure Test is another commonly used test. It requires visuospatial and executive functions, and may also serve as a measure of visuospatial memory. Finally, the legal aspects of the assessments are discussed with reference to the practices used in Great Britain, Belgium, Sweden, and Germany. In Poland, there are no detailed standards for post-stroke fitness-to-drive assessment.