Older drivers are more likely to have difficulty wayfinding in unfamiliar areas than younger people. The present study investigated the role of cognitive functioning and age on wayfinding difficulties and driving performance whilst driving in unfamiliar areas. Forty-seven participants aged between 21 and 82 years completed a wayfinding task in a driving simulator and a battery of neuropsychological tests. Older age was related to reduced driving speed and increased time stopped during the drive. Cognitive variables associated with wayfinding difficulties and driving performance decrements included processing speed, visuospatial ability, and aspects of memory, including verbal and visual immediate and delayed recall. This research suggests that older drivers, particularly those with poorer cognitive functioning, had more difficulty with wayfinding in unfamiliar areas than younger drivers. The findings are discussed with reference to potential safety and mobility benefits of alternative wayfinding strategies.

Passenger collaboration offers a potential compensatory strategy to assist older drivers who have difficulty driving in unfamiliar areas (wayfinding). This article describes a survey of 194 healthy, community-dwelling older drivers and their regular passengers to investigate how passengers assist drivers, and to identify the characteristics of drivers and passengers who regularly collaborate to assist with wayfinding. Three aspects of passenger assistance were investigated: Pre-trip planning, directional guidance and searching for visual cues. Results revealed a high incidence of collaboration amongst drivers and passengers who regularly drive together. Collaboration was dependent on the perceived wayfinding abilities of the driver by both passenger and driver, suggesting that passengers are more likely to help if they think they will be of assistance. This information provides baseline information on which future research can examine the safety benefits of passenger assistance in wayfinding.

O r i g i n a l Acceptance of navigation systems by older driversSome older drivers have difficulty with wayfinding in unfamiliar areas [1][2][3] .Wayfinding whilst driving in unfamiliar areas is a complex activity which involves planning and remembering a route, finding information in the environment and using it to navigate, maintaining orientation to maps or directions and executing the correct driving manoeuvres 4,5 .Portable or built-in automotive navigation systems have the potential to provide automated solutions for many tasks associated with wayfinding.There is emerging evidence suggesting that newer generation navigation systems can reduce older drivers' driving performance decrements compared to use of paper or electronic maps 6,7 .An important element of the success of any Intelligent Transport System (ITS) technology is whether the technology is adopted by the target group 8 .A recent study has found that older drivers, particularly those aged over 75 years, are less likely to own and regularly use navigation systems compared with younger drivers 9 .Little is known about the characteristics of older drivers who are slow to adopt navigation technologies.Research findings describing use of other kinds of technologies amongst older adults found that that participants who were older, had poorer health, a lower education and female gender were, generally, less likely to be willing to use technology 10,11 .It is also important to determine whether some older drivers have concerns about aspects of navigation systems which lead to rejection of the technology.Attitudes towards the technology before (acceptability) and after use (acceptance) should both be considered 12 .The United Theory of Acceptance and Use of Technology (UTAUT) model 13 provides a systematic approach for the study of potential barriers and facilitators to use of ITS.The model describes categories of attitudes towards a system: Performance Expectancy (PE), Effort Expectancy (EE) and social influence.These attitudes predict intention to use a system.Intention to use, along with facilitating conditions (provision of support to use the system and having access to the system) predict actual use of technology 13

Hypothalamic pituitary adrenal (HPA) axis hyperactivity has been linked to learning and memory difficulties in a range of neurodegenerative and neuropsychiatric conditions. In Huntington’s disease (HD), both declines in learning and memory and HPA axis dysfunction are present early in the disease. However, the relationship between specific learning and memory deficits and HPA axis functioning in HD has not been examined. The aim of this study was to investigate cortisol levels in relation to verbal learning and memory in pre-diagnosed (pre-HD) participants and patients at the early stages of diagnosed HD (early-HD). Cortisol concentration was assayed in saliva samples from 57 participants (17 early-HD, 20 pre-HD, and 20 controls) at four time-points across a 24-h period. Verbal memory was assessed using the California Verbal Learning Test—Second Edition (CVLT-II). We focused statistical analyses on the late evening cortisol concentration, and examined cortisol levels and verbal memory function in relation to diagnostic group (control, pre-HD, early-HD), and in a separate set of analyses combining pre-HD and early-HD (and excluding controls) we also examined cortisol and verbal memory performance in relation to the severity of HD-related motor signs. Of these two classification approaches, HD motor sign severity was more strongly associated with high evening cortisol levels and both reduced information encoding and memory retrieval. Separately, there was also a trend of higher cortisol levels in pre-HD. The findings suggest hypercortisolism and the underlying pathological changes may begin many years before a clinical diagnosis is made, but the memory decline associated with HPA axis disturbance may only become detectable once motor signs become pronounced.

This study investigated attitudes toward financial elder abuse by sections of the Australian community using three focus groups, including Aged Care Workers, Older Adults, and Younger Adults. Participants were provided discussion cues prior to their focus group (i.e., What is financially abusive behavior? Why does it occur? How can it be prevented?). Two researchers authenticated the transcripts and identified micro- and macro-level themes within and across the groups. The study revealed a range of similar, different, and individual attitudes expressed across the groups, which could be used to develop a survey for a broader investigation of the role of individual attitudes and social/cultural norms in financial elder abuse.

Some older drivers experience difficulties driving whilst wayfinding in unfamiliar areas. Difficulties in wayfinding have been associated with poorer driving performance and reduced driving mobility. The objective of the current study was to identify cognitive and demographic predictors in older drivers of perceived wayfinding difficulty, avoidance of unfamiliar areas and the use of wayfinding strategies. Five hundred and thirty-four drivers aged 65 years and over (excluding those with dementia or Parkinson's disease) completed a mail-out survey. Drivers commonly reported difficulties with wayfinding, with 59.5% reporting their abilities as poor or fair rather than good. Those significantly more likely to report difficulty were older, reported poorer health and cognition, and had less driving experience. A small proportion of drivers reported regularly avoiding unfamiliar areas (13.8%); these drivers were significantly more likely to be female and to report poorer wayfinding abilities. The most common wayfinding strategies regularly used by older drivers were using a street directory whilst driving (61.9%) and pulling over to check the map (55.1%). Regular passenger guidance (23.9%) or use of a navigation system (9.9%) was less common. The implications of this study are wide and include collecting further information about: (1) the role of cognitive processes in wayfinding ability; (2) the relationship between perceived wayfinding difficulty and restriction of driving in unfamiliar areas; and (3) older drivers' preferences for different wayfinding strategies.

Hypothalamic-pituitary-adrenal (HPA) axis dysfunction and depression have both been shown to occur in Huntington's disease (HD) gene carriers prior to diagnosis (pre-HD) and in diagnosed HD patients. However, the relationship between HPA axis dysfunction and the severity of depressive symptomatology in pre-HD and early-HD has not been systematically examined, despite morning hypercortisolism being a characteristic feature of some subtypes of idiopathic depression. The aim of this study was to investigate whether HPA axis function is related to levels of depression in pre-HD and early-HD. To assess HPA axis function we obtained salivary cortisol concentrations from 20 controls, 20 pre-HD, and 17 early-HD participants at four time points over a 24h period. Depression symptoms were assessed using the Inventory of Depressive Symptomatology – Self-Report. Of the participants who were found not to be depressed, the early-HD group had significantly lower morning cortisol levels relative to pre-HD and controls. In contrast, the early-HD group with at least mild or greater levels of depression symptoms had a comparable cortisol concentration to pre-HD and controls. The results suggest that early-HD may be associated with hypocortisolism. However when depressed, a hyperactive HPA axis response may still be induced in early-HD and lead to cortisol levels that are similar to pre-HD and controls. Our study reveals that cortisol levels in HD may be modified by the presence or absence of depressive symptomatology. Depression may be an important factor for understanding how the HPA axis is affected in HD, particularly in the morning.

While there is a large body of research indicating that individuals with moderate to severe dementia are unfit to drive, relatively little is known about the driving performance of older drivers with mild cognitive impairment (MCI). The aim of the current study was to examine the driving performance of older drivers with MCI on approach to intersections, and to investigate how their healthy counterparts perform on the same driving tasks using a portable driving simulator. Fourteen drivers with MCI and 14 age-matched healthy older drivers (aged 65–87 years) completed a 10-min simulator drive in an urban environment. The simulator drive consisted of stop-sign controlled and signal-controlled intersections. Drivers were required to stop at the stop-sign controlled intersections and to decide whether or not to proceed through a critical light change at the signal-controlled intersections. The specific performance measures included; approach speed, number of brake applications on approach to the intersection (either excessive or minimal), failure to comply with stop signs, and slower braking response times on approach to a critical light change. MCI patients in our sample performed more poorly than controls across a number of variables. However, because the trends failed to reach statistical significance it will be important to replicate the study using a larger sample to qualify whether the results can be generalised to the broader population.

Cholesterol is a modifiable risk factor that has been associated with higher incidence of dementia/cognitive impairment and more decline in cognitive function. Previous studies have shown conflicting results in relation to cross-sectional cholesterol and cognition. Given the variability of lipid profiles and the long prodromal period of disease development to dementia, the pattern of variability of lipid levels over time may be more important than the absolute level. 254 women (mean age = 60 years) from the longitudinal prospective Women's Healthy Ageing Project who had their serum lipids (total cholesterol, HDL-C and LDL-C) measured annually from 1992 to 2002 and completed cognitive tests that assessed processing speed and episodic memory in 2002 were included in this study. Speed of processing was assessed with the oral version of the Symbol-Digits Modalities Test (SDMT) while episodic verbal memory was evaluated with a composite z-score computed across two verbal learning tests. The variability of lipid values over time for each participant was calculated as the variance of the residuals of each participant from their regression model of cholesterol on age. All analyses were adjusted for age, years of education, APOE-ɛ4 status and medication use. Women whose HDL-C levels demonstrated high levels of fluctuation over the decade of follow-up were more likely to have both a reduced immediate (P< 0.05) and delayed episodic memory (P< 0.05) after age 55. This dataset provided the unique opportunity to demonstrate that whilst absolute levels of HDL-C may not associate with cognition, a high HDL-C variability over the decade preceding cognitive testing may be a contributing factor to reduced episodic memory in late-life. This data suggests a role for lipids in the development of cognitive decline and support the importance of variability over and above absolute levels at any cross-sectional time point. Longitudinal measures of biomarkers with significant variability are essential in examining association with disease.

Cholesterol is a modifiable risk factor that has been associated with higher incidence of dementia/cognitive impairment and more decline in cognitive function. Studies to date have shown conflicting results of cholesterol and cognition. Given that we know that earliest changes of dementia occur one to two decades before diagnosis, it is likely that mid-life factors may have a significant development of disease. The WHAP has both midlife and late life measures of lipid profile over a decade of follow-up and late life cognition. 254 women (mean age = 60 years) from the longitudinal prospective Women's Healthy Ageing Project who had their serum lipids (total cholesterol, HDL-C and LDL-C) measured annually from 1992 to 2002 and completed cognitive tests that assessed processing speed and episodic memory in 2002 were included in this study. Speed of processing was assessed with the oral version of the Symbol-Digits Modalities Test (SDMT) while episodic verbal memory was evaluated with a composite z-score computed across two verbal learning tests. The influence of midlife and late-life risk of abnormal lipid profiles was calculated. All analyses were adjusted for age, years of education, APOE4 status and medication use. In this cohort of Australian women, both midlife and later life higher total cholesterol was a significant predictor of slower processing speed (P < 0.05). Having a higher midlife LDL-C significantly predicted later life reduced immediate episodic memory (P < 0.05) whereas having high late life LDL-C was associated with a slower processing speed at the time of testing (P < 0.05). The data suggest a possible cause for the inconsistency in associations between lipid profiles and cognition as the relationship between profile and cognitive performance changes over time. The importance of examining midlife risk factors for late life cognitive decline is highlighted.

Driving to an unfamiliar location can be one of the most difficult driving situations a motorist can face. Age-related declines in cognitive abilities may make wayfinding while driving even more challenging for some older drivers. Unfortunately most previous studies have been limited by small sample sizes, and the true scope of this problem remains unknown. Additionally, most studies have focused on age as a whole rather than declines in health and cognition. A self-reported questionnaire was administered to gain a better understanding of the prevalence and characteristics of drivers aged 65 and over who reported difficulty with wayfinding, and to determine strategies used to help with wayfinding. Drivers were recruited through an automobile club membership in the state of Victoria, Australia, and survey responses were received from 536 drivers. Over half of respondents reported some difficulty with wayfinding in unfamiliar areas, with 14% reporting that they avoided driving in unfamiliar areas often or always. Drivers within the overall sample were more likely to rely on their own wayfinding skills (e.g. using a street directory or their memory) rather than on external sources such as a passenger or an electronic navigation system. Nevertheless, almost one quarter of respondents reported using their passenger to assist in unfamiliar areas often or always, while 10% of respondents reported using an electronic navigation system often or always. Drivers who reported more difficulty with wayfinding tended to be older and also reported more difficulties with their health and cognitive abilities. They were also more likely to rely on passengers, ask for directions on-route or pull over to check the map. The study provided a rich data source for understanding the role of driving behaviours and driver characteristics associated with wayfinding difficulties and the results confirm that wayfinding is a challenging driving task for many older drivers. Moreover, this study has provided insight into the types of strategies utilised by drivers to assist with wayfinding.

Associate-recognition has received little attention as a potential clinical tool for detecting early Alzheimer's disease (AD). As an important preliminary stage to investigating the paradigm's diagnostic utility, we designed and administered a verbal associate-recognition task to healthy elderly participants (n = 62) and compared their performance to that on traditional cued-recall PAL. In both test conditions, the stimulus list comprised of a mixture of highly imageable and less imageable word pairs. Overall, performance on the associate-recognition task was superior to that on the cued-recall analogue. This 'recognition advantage' was not attributable to the higher baseline or chance guessing rate in the associate-recognition condition, as the size of the recognition advantage varied across learning trials and stimulus imageability. In comparison to performance on the imageable stimuli, performance on the less imageable stimuli was poor in both associate-recognition and cued-recall conditions. Across the delay, performances were more likely to drop in the cued-recall condition than the associate-recognition condition. These results suggest that verbal associate-recognition may be clinically efficacious and better tolerated in elderly populations than traditional cued-recall paradigms. Although these results are encouraging, further research is required to examine the utility of associate-recognition in clinical populations, particularly early AD.

The primary impairment in early Alzheimer's disease (AD) is encoding/consolidation, resulting from medial temporal lobe (MTL) pathology. AD patients perform poorly on cued-recall paired associate learning (PAL) tasks, which assess the ability of the MTLs to encode relational memory. Since encoding and retrieval processes are confounded within performance indexes on cued-recall PAL, its specificity for AD is limited. Recognition paradigms tend to show good specificity for AD, and are well tolerated, but are typically less sensitive than recall tasks. Associate-recognition is a novel PAL task requiring a combination of recall and recognition processes. We administered a verbal associate-recognition test and cued-recall analogue to 22 early AD patients and 55 elderly controls to compare their ability to discriminate these groups. Both paradigms used eight arbitrarily related word pairs (e.g., pool-teeth) with varying degrees of imageability. Associate-recognition was equally effective as the cued-recall analogue in discriminating the groups, and logistic regression demonstrated classification rates by both tasks were equivalent. These preliminary findings provide support for the clinical value of this recognition tool. Conceptually it has potential for greater specificity in informing neuropsychological diagnosis of AD in clinical samples but this requires further empirical support.

We propose that the earliest neuropsychological detection of Alzheimer's disease (AD) can be informed by current views about the neuropathogenesis of AD and cognitive models of memory and its neurobiological substrates. The primary impairment in early AD is encoding/consolidation, resulting from medial temporal lobe (MTL) pathology. On theoretical and empirical grounds, paired associate learning (PAL) appears to be the ideal paradigm for detecting MTL dysfunction in early AD. It has not been embraced as a test of choice, however, and this critical review discusses why the paradigm may have not fulfilled its potential. We suggest that a new PAL variant, 'associate-recognition', may prove to be clinically efficacious.

Driving to an unfamiliar location is one of the most difficult driving situations a motorist can face. Furthermore, potential age-related declines in cognitive abilities such as attention and processing speed may make wayfinding while driving even more challenging for some older drivers. A survey of 536 drivers over the age of 65 was conducted to understand more fully the methods used and attitudes to new technologies. Over half of respondents reported some wayfinding difficulty. People who reported more difficulty with wayfinding tended to be older and reported poorer health and cognitive abilities. Drivers who reported poorer wayfinding abilities were more likely to rely on passengers, ask for directions on-route and pull over. Difficulties with wayfinding did not affect future use of GPS or attitudes towards the cost, safety and navigation effectiveness of GPS. The results confirm that wayfinding is a challenging driving task for many drivers over the age of 65 and provide insight into the types of strategies utilised by drivers to assist with wayfinding.