Driving Patterns in Older Adults May Signal Early Brain Changes and Dementia Risk

A study tracking older adults' driving habits over five years has revealed that subtle changes in everyday driving patterns may provide early warning signs of brain changes and higher dementia risk, even before traditional memory and thinking symptoms appear. The research, to be presented at the American Stroke Association's International Stroke Conference 2026, followed 220 adults aged 65 and older living independently in St. Louis, Missouri, using car sensors to monitor driving behavior for more than five years.

Researchers found that older adults with greater white matter damage in the brain, specifically white matter hyperintensities caused by reduced blood flow to brain tissue, tended to drive less and show sharper declines in their willingness or ability to change driving routes and habits. Among the 17% of participants who developed cognitive impairment during the study, higher white matter hyperintensity burden was linked to a greater likelihood of unsafe driving practices, such as hard braking, and to more crashes. White matter damage in the back part of the brain, which helps process visual information and coordinate movement, was most strongly tied to unsafe driving and crashes.

According to study author Chia-Ling Phuah, M.D., M.M.Sc., of Barrow Neurological Institute in Phoenix, these findings suggest that monitoring driving behavior with commercial in-vehicle data loggers may help identify older adults at higher risk for unsafe driving, loss of independence and subtle cognitive problems. The research is particularly relevant given that about 6.9 million adults 65 years or older in the United States were living with Alzheimer's disease in 2024, according to the American Heart Association 2026 Heart and Stroke Statistics available at https://www.heart.org/en/statistics.

One notable finding was that participants taking medications to manage high blood pressure, especially angiotensin-converting enzyme (ACE) inhibitors, were less likely to exhibit risky driving when compared with those not taking blood pressure medication. This effect was observed regardless of whether blood pressure levels were at target levels, suggesting these medications may help support brain health as we age. Nada El Husseini, M.D., M.H.Sc., FAHA, chair of the American Heart Association's 2023 scientific statement on cognitive impairment after stroke, noted that what's surprising is that people taking ACE inhibitors were less likely to have impairment in their driving despite the extent of white matter disease.

The study's limitations include a small sample size, with most participants being white, college-educated adults, meaning results may not generalize to more diverse populations. Medication use was self-reported, which could introduce errors. The next step will be larger studies with more diverse participants to confirm and extend these findings. The research adds to growing evidence about the connection between cardiovascular health and brain function, as highlighted in resources like the American Heart Association's Brain Health & Healthy Aging Infographic at https://www.heart.org/en/healthy-living/healthy-lifestyle/brain-health.

For caregivers like Pam Duncan, whose husband Larry was diagnosed with Alzheimer's in 2023, driving changes served as an early indicator of cognitive challenges. She notes that in early-stage cognitive impairment, symptoms can be subtle, and driving is one of them. The study's findings underscore the importance of awareness and monitoring of driving patterns as potential indicators of brain health changes in older adults.