A preliminary study to be presented at the American Stroke Association's International Stroke Conference 2026 suggests that monitoring driving habits in older adults may provide early warning signs of cognitive decline and dementia. The research, which followed 220 adults aged 65 and older for more than five years, found that greater white matter damage in the brain—specifically white matter hyperintensities caused by reduced blood flow—was associated with decreased driving, fewer trips, repetitive routes, and more driving errors, particularly in those who later developed dementia.
White matter hyperintensities in the back part of the brain, which processes visual information and coordinates movement, were most strongly linked to unsafe driving and crashes, pointing to a potential early marker for higher driving risk. According to study author Chia-Ling Phuah, M.D., M.M.Sc., an associate professor of neurocritical care and co-director of the Neuro Analytics Center at Barrow Neurological Institute in Phoenix, "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."
In contrast, participants taking blood pressure medications, particularly angiotensin-converting enzyme (ACE) inhibitors, were less likely to exhibit risky driving behaviors even when brain damage was present. This effect was observed regardless of whether blood pressure levels were at target. 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, "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. The impact of ACE inhibitors on cognitive function and driving safety in people with white matter disease requires further investigation."
The study included 220 adults with an average age of 73, mostly white and college-educated, living independently in St. Louis, Missouri. Researchers used car sensors to track driving behavior, including speeding, collisions, hard braking, and hard cornering, over five years. Brain MRI scans measured white matter hyperintensities at enrollment, and participants underwent annual cognitive assessments. Over the follow-up period, 17% developed cognitive impairment, mostly Alzheimer's disease, and among those, higher white matter hyperintensity burden was linked to unsafe driving practices and more crashes.
The findings suggest that monitoring driving behavior with commercial in-vehicle data loggers may help identify older adults at higher risk for unsafe driving and subtle cognitive problems. Phuah emphasized, "One especially promising finding was that people taking blood pressure medications, particularly ACE inhibitors, tended to maintain safer driving habits even when their brain scans revealed more damage. This suggests that these medications may help support brain health as we age." However, the study has limitations, including a small sample size and lack of diversity, so larger studies are needed to confirm the results.
The American Heart Association's 2026 Heart and Stroke Statistics note that about 6.9 million adults 65 or older in the U.S. were living with Alzheimer's disease in 2024. For more information on brain health, visit the American Stroke Association's Stroke Hub.
