A preliminary study presented at the American Stroke Association's International Stroke Conference 2026 suggests that older adults' driving habits can reveal early changes in brain health, potentially signaling cognitive decline or dementia before traditional symptoms appear. The research, part of the Driving Real-World In-Vehicle Evaluation System (DRIVES) project at Washington University in St. Louis, followed 220 adults aged 65 and older for over five years, using car sensors to track driving behavior and brain imaging to measure white matter hyperintensities—areas of damage caused by reduced blood flow to brain tissue.
The study found that participants with greater white matter damage tended to drive less, take fewer trips, and follow more repetitive routes. Among the 17% of participants who developed cognitive impairment—most diagnosed with Alzheimer's disease—higher white matter hyperintensity burden was linked to unsafe driving practices, such as hard braking, and more crashes. Notably, damage in the back of the brain, which processes visual information and coordinates movement, was most strongly tied to unsafe driving and crashes, suggesting a potential early marker for driving risk.
However, researchers observed a protective effect among participants taking blood pressure medications, particularly angiotensin-converting enzyme (ACE) inhibitors. These individuals were less likely to exhibit risky driving behaviors even when brain scans revealed significant white matter damage. This effect was independent of whether their blood pressure was at target levels, hinting that ACE inhibitors may help support brain health as we age.
“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 at Barrow Neurological Institute.
Nada El Husseini, M.D., M.H.Sc., FAHA, chair of the American Heart Association’s 2023 scientific statement on cognitive impairment after stroke and an associate professor at Duke University Medical Center, 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. The impact of ACE inhibitors on cognitive function and driving safety in people with white matter disease requires further investigation.”
The study's limitations include a small, predominantly white and college-educated sample, and self-reported medication use. Researchers call for larger, more diverse studies to confirm these findings. The American Heart Association notes that normal blood pressure is less than 120/80, and treatment is recommended for levels 140/90 mm Hg or higher to maintain brain health.
According to the American Heart Association 2026 Heart and Stroke Statistics, about 6.9 million adults 65 or older in the U.S. were living with Alzheimer's disease in 2024. The findings suggest that monitoring driving behavior with in-vehicle data loggers could help identify older adults at risk for unsafe driving and cognitive problems. As Pam Duncan, caregiver for her husband with Alzheimer's, noted: “In early-stage cognitive impairment, symptoms can be subtle, and driving is one of them. Don’t ignore these changes.”
