A preliminary study presented at the American Stroke Association's International Stroke Conference 2026 suggests that subtle changes in older adults' driving habits may provide early clues about brain health and cognitive decline. The research, which followed 220 adults aged 65 and older over five years, found that greater damage to the brain's white matter was associated with decreased driving, fewer trips, repetitive routes, and more driving errors, particularly among those who later developed dementia.
White matter hyperintensities—areas of damage caused by reduced blood flow to brain tissue—were measured using MRI scans at the start of the study. Participants, who were free of dementia at enrollment, had their driving behavior tracked via in-vehicle sensors that recorded metrics such as speeding, hard braking, hard cornering, and collisions. Over the follow-up period, 17% of participants developed cognitive impairment, most diagnosed with Alzheimer's disease. Among these individuals, higher white matter burden was linked to unsafe driving practices and more crashes.
Notably, white matter damage in the posterior brain region, which processes visual and motor coordination, was most strongly tied to unsafe driving and crashes. This finding highlights a potential early warning marker for driving risk in older adults. Conversely, participants taking blood pressure medications, particularly ACE inhibitors, were less likely to exhibit risky driving behaviors, even when brain damage was present. This effect occurred regardless of whether blood pressure levels were at target, suggesting these medications may help preserve brain health.
“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., an associate professor of neurocritical care at Barrow Neurological Institute. The findings indicate that monitoring driving behavior with commercial in-vehicle data loggers could help identify older adults at higher risk for unsafe driving and cognitive problems.
Nada El Husseini, M.D., M.H.Sc., FAHA, chair of the American Heart Association’s 2023 scientific statement on cognitive impairment after stroke, commented, “What’s surprising about these findings is that people taking ACE inhibitors were less likely to have impairment in their driving despite the extent of white matter disease.” She added that further investigation is needed, and that cognitive screening and brain imaging might be considered for individuals with driving difficulties.
The study, part of the Driving Real-World In-Vehicle Evaluation System (DRIVES) project at Washington University in St. Louis, included mostly white, college-educated adults, so results may not generalize to diverse populations. Medication use was self-reported, which could introduce errors. The American Heart Association’s 2026 Heart and Stroke Statistics note that about 6.9 million U.S. adults 65 or older were living with Alzheimer’s disease in 2024. The researchers call for larger, more diverse studies to confirm these findings.
For more information on brain health and stroke, visit www.stroke.org or www.DerrameCerebral.org.
