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Thursday, September 23, 2021

Alzheimer and Driving

There are insurance companies that will potentially offer you a lower rate if you agree to their persistent if not constant, monitoring. According to Pew Research, there is no consensus as to the appropriateness of such monitoring. Because you would be electing such consciously, there is also the probability for the Hawthorne Effect bias to impact the validity of any data that is collected by such a study of your driving. 

The Hawthorne is simply that "people behave differently because they know they are being watched." Retailers and others have relied on the implications of this for years with faux video cameras, potentially one-way mirrors, and more. Thus, if you want to study driver behavior, there is a detriment or challenge in the subject knowing s/he is being studied. But, if you want someone to drive more carefully, there is perhaps a benefit in the driver believing they are being watched. 

The bottom line for auto insurers is the belief that drivers will be safer and more careful if they believe the device installed on their vehicle is both tracking and reporting their activity. With the volume of information available today, such a device can not only discern where you are and your speed, but it can also compare that to the posted speed limit, note your consistency (or lack thereof), and more. Thus, you will rationally be more conscious of speed and driving because Hawthorne is watching.

The potential for Hawthorne came to me recently in the research context, however, when perusing an article on Alzheimer's published by the British Broadcasting Corporation (BBC): "How your driving might reveal early signs of Alzheimer's." It describes an interesting intersection of technology, medicine, and our anticipations.

They hypothesize that we all see an alteration in our driving as we age. This reminded me of a recent conversation in which my friend Horace Middlemier described a ride with an 86-year-old neighbor. The description included slow driving in the left lane, long periods of turn signal flashing with no intention of a turn, and the passing by of various cars whose drivers were expressive in both auditory and hand signal communications. The BBC acknowledges that many people's "driving changes as they age," and that this is normal. However, it reports on a study that may suggest our driving could foretell potential for more serious issues such as Alzheimer's.

The experiment begins with a very small group (139) of drivers over 65 years of age in Missouri. They volunteered "to have their driving closely monitored for one year." Thus, they knew they were being watched (see Hawthorne, supra). About half of the volunteers had been diagnosed with "preclinical Alzheimer's disease," which is not necessarily the disease as much as a potential precursor or predictor. The drivers' habits were monitored by a group at Washington University in St. Louis as they went about the daily business of their lives.

The study concluded that "those with preclinical Alzheimer's" exhibited driving tendencies that the others in the group did not. This included diving slower, "making abrupt changes" more often, as well as "travel(ling) less at night, and" driving "fewer miles overall." The study also found pertinence in the variety of "visited . . .destinations" and the manner in which they kept to "slightly more confined routes." From this, perhaps we readily see some Hawthorne as to frequency, duration, or timing of trips? Perhaps this also implicates the slower speed? But, perhaps the “abrupt changes” might not be such a reaction?

From the collected data, the researchers believe they can "forecast someone's likelihood of having preclinical Alzheimer's" based on driving habits. From their calculations, they concluded this predictive modeling "to be 86% accurate." The size of the study raises caution, and the researchers concede that "larger, randomized studies are needed to show a definitive link between the detected driving behaviors and preclinical Alzheimer's disease." 

Randomized, perhaps to also study subjects not subject to Hawthorne’s? Is there any methodology in which the driving habits might be observed without the subject's knowledge? This is not, as yet, a definitive predictor. In drug trials, there is uncertainty introduced by some subjects getting a placebo. Might they study a larger group and at least tell them that everyone gets a device on their car, but not all of the devices work?

There is no mention in the article of Hawthorne. Those who had been diagnosed with "preclinical Alzheimer's disease" might have in fact altered their behavior based on the diagnosis alone, age alone, or a variety of other reasons. Might you, with such an Alzheimer’s warning or diagnosis, drive more slowly? Might you limit your driving, your nighttime driving, or stick to familiar routes? As to routes, don't we all tend to stick to our familiar routes? Might you become more tentative in some situations? Could it be that caution comes from knowledge and diagnosis as well as it might from the disease process itself?

There are those quoted in the story that think there is more study of this hypothesis needed. There is interest in longer studies. Some comments suggest that more focus on the ability to plan a trip from “A” to “B” and a comparison of alternate routing elected spontaneously thereafter (getting lost) might be of interest as well. Another notes that “there is always the possibility that errors could creep into this analysis.” Despite these challenges, in the end, it is perhaps good news that medicine might spot “preclinical” disease process. However, the study authors admit “there is always the possibility that errors could creep into this analysis.”

Of course, the bad news is that there is little that can be done about such a condition. The sources cited note that “there are currently relatively few drugs available to treat early Alzheimer's disease.” Thus, unlike a condition such as “pre-diabetes,” knowing of a preclinical manifestation might not bring treatment at this time. However, knowing is half the battle in some contexts, and a diagnosis may be significant in one's personal battle. The implications of such a study are intriguing and the potential for earlier diagnosis is perhaps worthwhile. 

Perhaps our government will one day mandate such monitoring of all cars, strictly for safety? Perhaps without such privacy invasion, some of us might knowingly and willingly consent to have such data collected about us through some simple application on our cell phones, such as maps, Waze, or similar? Perhaps, the ability for our movement, pace, and path are already present and merely waiting to be mined and analyzed?