White Matter Hyperintensities Predict Driving Behavior Changes in Preclinical Alzheimer’s Disease

Topic: Amyloid, tau and blood-test diagnosis

Our study included 74,275 weeks of driving data (2015-2024, average follow-up 6.1 years). Increased WMH burden correlated with decreased trip frequency (p = 0.0005), fewer near-home trips (p = 0.0004), reduced unique destinations (p = 0.0003), and lower driving entropy (p = 0.001) over time. Decrease in driving complexity was primarily driven by posteriorly-located WMH lesions, especially in parietal and occipital regions (β=-0.09, p = 0.002 and β=-0.10, p = 0.0009, respectively) involved in visual processing, motion detection and spatial awareness. WMH impact on driving behavior intensified over time in participants developing cognitive impairment (n = 36), manifesting as increased hard breaking and impact events. WMH in OA significantly impacts driving behavior, leading to latent self-regulation and reduced driving complexity. Cognitive impairment with WMH increases risky driving. Posterior WMH influence suggests a dominant role of AD pathology in driving performance decline. WMH shows potential as a biomarker for identifying individuals at higher risk of unsafe driving and premature driving cessation, highlighting its value in early screening and intervention strategies for road safety among aging populations, particularly those at risk for AD.

Key findings

• Our study included 74,275 weeks of driving data (2015-2024, average follow-up 6.1 years).
• Increased WMH burden correlated with decreased trip frequency (p = 0.0005), fewer near-home trips (p = 0.0004), reduced unique destinations (p = 0.0003), and lower driving entropy (p = 0.001) over time.
• Decrease in driving complexity was primarily driven by posteriorly-located WMH lesions, especially in parietal and occipital regions (β=-0.09, p = 0.002 and β=-0.10, p = 0.0009, respectively) involved in visual processing, motion detection and spatial awareness.
• WMH impact on driving behavior intensified over time in participants developing cognitive impairment (n = 36), manifesting as increased hard breaking and impact events.
• WMH in OA significantly impacts driving behavior, leading to latent self-regulation and reduced driving complexity.

Why it matters

This study found that more white matter hyperintensities were linked to simpler driving patterns over time, and that in people developing cognitive impairment, risky driving events increased. It suggests these brain changes may help identify people at risk of unsafe driving, but it does not test a treatment, cure, or prevention.

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Study details

• Study designlongitudinal study
• Participants36
• Evidence strengthModerate

Read the original

• DOI: 10.1002/alz70862_110306
• PubMed: 41433463
• Original source →
• Free full text: Alzheimer s & Dementia →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{phuah2025-41433463,
  author  = {Phuah, Chia‐Ling and Parihar, Madhur and Chen, Yasheng and Carr, David B. and Lee, Jin‐Moo and Babulal, Ganesh Muneshwar},
  title   = {{White Matter Hyperintensities Predict Driving Behavior Changes in Preclinical Alzheimer’s Disease}},
  journal = {Alzheimer s \& Dementia},
  year    = {2025},
  doi     = {10.1002/alz70862_110306},
  pmid    = {41433463},
  url     = {https://doi.org/10.1002/alz70862_110306}
}

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