A study following over 200 adults for five years revealed that greater white matter damage in the brain was associated with decreased driving, fewer trips, repetitive routes, and more driving errors, particularly among those who later developed dementia. Researchers tracked 220 volunteers aged 65 and older living independently in St. Louis, Missouri, using car sensors to monitor driving behavior for more than five years. Brain imaging conducted within the study's first year measured white matter hyperintensities, finding that older adults with more of these brain changes tended to drive less and showed sharper declines in their ability to adapt driving routes and habits.
During the follow-up period, 17% of participants developed cognitive impairment, with most later diagnosed with Alzheimer's disease. Among this group, higher white matter hyperintensity burden was linked to unsafe driving practices like hard braking and more crashes. Participants with white matter hyperintensities located in the back of the brain faced even higher crash risks than those with changes in other areas. In contrast, adults aged 65 and older taking blood pressure medications, particularly ACE inhibitors, were less likely to exhibit risky driving behaviors even when brain damage was present.
The 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. One notable discovery was that people taking blood pressure medications, especially ACE inhibitors, tended to maintain safer driving habits despite brain scan evidence of damage, indicating these medications may support brain health with age. Recent research confirms blood pressure affects brain health, including cognitive function and dementia, so early treatment is recommended for those diagnosed with high blood pressure to maintain brain health and cognition, according to the 2025 American Heart Association High Blood Pressure Guideline.
Key limitations include a small study size, with most participants being white, college-educated adults, meaning results may not generalize to more diverse populations, and medication use was self-reported, potentially introducing errors. The next step involves larger studies with more diverse participants to confirm and extend these findings. The study is a research abstract to be presented at the American Stroke Association's International Stroke Conference 2026. Abstracts presented at the Association's scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
