Subtle shifts in driving behavior among older adults may provide early clues about brain health changes and elevated dementia risk, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The study of 220 adults aged 65 and older found that greater white matter damage in the brain was associated with decreased driving, fewer trips, repetitive routes, and more driving errors, particularly in those who later developed cognitive impairment.
Researchers tracked participants' driving for over five years using car sensors that monitored speeding, collisions, hard braking, and hard cornering. Brain imaging conducted within the study's first year measured white matter hyperintensities—areas of damage caused by reduced blood flow. The analysis revealed that participants with more white matter damage tended to drive less and showed sharper declines in their ability to vary routes. Over the follow-up period, 17% developed cognitive impairment, most later diagnosed with Alzheimer's disease.
"Driving habits in older adults can reveal early changes in brain health. How often people drive, where they go, and how much they vary their routes may signal underlying damage to the brain's white matter, which is linked to cognitive decline and dementia," said study author Chia-Ling Phuah, M.D., M.M.Sc., of Barrow Neurological Institute. White matter damage in the back of the brain, which processes visual information and coordinates movement, was most strongly tied to unsafe driving and crashes.
A notable finding was that participants taking blood pressure medications, particularly angiotensin-converting enzyme (ACE) inhibitors, were less likely to exhibit risky driving behaviors even when brain scans showed white matter damage. "This suggests that these medications may help support brain health as we age," Phuah noted. Nada El Husseini, M.D., M.H.Sc., FAHA, chair of the American Heart Association's 2023 scientific statement on cognitive impairment after stroke, said the impact of ACE inhibitors on driving safety in people with white matter disease requires further investigation.
The study's implications are significant for public health and aging populations. According to the American Heart Association 2026 Heart and Stroke Statistics, about 6.9 million adults 65 and older in the United States were living with Alzheimer's disease in 2024. Monitoring driving behavior with commercial in-vehicle data loggers could help identify older adults at higher risk for unsafe driving and subtle cognitive problems, potentially allowing for earlier interventions.
Limitations include the study's small size and lack of diversity—most participants were white, college-educated adults—so results may not generalize to broader populations. The research is preliminary, as abstracts presented at the association's scientific meetings are not peer-reviewed. The findings will need confirmation through larger, more diverse studies. The study was part of the Driving Real-World In-Vehicle Evaluation System project based at Washington University in St. Louis.
