Cognitive and Social Determinants Affecting Driving After Moderate-to-Severe Traumatic Brain Injury

Purpose/Objective: Moderate-to-severe traumatic brain injury (TBI) often results in cognitive deficits that hinder the ability to drive an automobile, which in turn hinders independence and quality of life. Determinants affecting the relationship between impaired cognition and return to driving have been understudied. The current study examined the relationship between cognition and driving status following moderate-to-severe TBI. Research Method/Design: Participants were 585 adults aged 19-96 (70% male) who sustained a moderate-to-severe TBI and were enrolled in the TBI Model System. Cross-sectional data were obtained (2018-2019) 1-30 years post injury (M = 8.2 years). Relationships were examined between driving status (active drivers vs. nondrivers), cognitive function (verbal memory, executive function), and covariates (demographics; injury factors including motor function; social factors). Results: About 70% were driving at interview. Higher memory (OR = 1.36, p < 0.05) and executive function (OR = 1.38, p < .001) scores predicted active driving status; however, the relationships were not significant when the covariates were included. Family income, motor function, and history of seizure were related to driving status (all p < .05). Income and motor function were related to memory and executive function (all p < .001), whereas seizure history was not. Conclusion/Implications: Memory and executive function are significantly associated with driving status following TBI, but these relationships dissipate after accounting for sociodemographic/injury factors, particularly family income and motor function. Further research is needed to understand the interplay of cognition with other factors in return to driving decisions.