University of Toronto Leads Groundbreaking Analysis on Dementia and Driving

A pioneering study from researchers at the University of Toronto's Temerty Faculty of Medicine has shed new light on how a dementia diagnosis influences the driving behaviors of older Canadians. Published in the Canadian Journal on Aging in early January 2026, this research draws from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort, examining data from 955 older adults across the country. Led by senior author Jennifer Campos, a professor in rehabilitation sciences and psychology, along with collaborators at University Health Network's KITE Research Institute, the study reveals nuanced patterns of self-regulation among those with cognitive challenges.

Driving represents one of the most demanding daily activities, integrating visual perception, decision-making, multitasking, and motor control in unpredictable environments. For older adults, maintaining this independence is vital, yet dementia—encompassing conditions like Alzheimer's disease (AD), vascular dementia, and others—progressively impairs these faculties. The research highlights that while many continue driving post-diagnosis, they adapt through strategic restrictions, balancing safety with autonomy.

Decoding the COMPASS-ND Dataset: Methodology and Participant Profile

The COMPASS-ND study, funded by the Canadian Consortium on Neurodegeneration in Aging (CCNA), is Canada's largest observational cohort tracking individuals with diverse neurodegenerative conditions. Participants undergo comprehensive evaluations, including neuropsychological testing, neuroimaging, and self-reports on daily functions like driving. This particular analysis stratified 955 drivers into four cognitive groups: cognitively normal (CN), subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia.

Ages ranged from 65 and older, reflecting Canada's aging demographic where over 20% of seniors hold driver's licenses. Data captured license status, driving frequency (daily, weekly, monthly, rarely), annual distance, self-imposed restrictions (e.g., no highways, no night driving), and cessation reasons. Notably, the cohort spanned multiple provinces, capturing regional variations in licensing norms—such as retaining licenses for identification in areas without easy passport access.

Core Findings: Dramatic Shifts in Frequency and Distance Post-Diagnosis

Among the 241 participants with dementia, 59% retained valid, unrestricted licenses, mirroring rates in less impaired groups. However, driving exposure plummeted: those with dementia drove significantly less often and covered shorter distances compared to CN peers. For instance, dementia drivers averaged fewer weekly outings, prioritizing essential trips like medical appointments or grocery runs.

• 41% of dementia cases had surrendered licenses or ceased driving entirely.
• Of non-drivers with dementia, 39% stopped following physician advice, underscoring medical gatekeeping.
• 33% opted out voluntarily, often citing personal safety concerns.

These patterns indicate robust self-awareness in early-to-moderate stages, where individuals compensate by avoiding high-demand scenarios. SCI participants—reporting subtle memory lapses despite normal tests—mirrored CN habits but showed early tendencies toward caution, flagging them as at-risk for progression.

Sex Differences Emerge as Key Influencer in Adaptation Strategies

Gender played a pivotal role across all groups. Women universally drove shorter distances and less frequently than men, a trend amplified in cognitive decline. Post-dementia diagnosis, females were twice as likely to cease voluntarily (prioritizing family input), while males awaited formal medical directives. This divergence may stem from socialization—men viewing driving as identity-linked—or physiological factors like spatial processing variances.

Campos notes, "It's really interesting to examine how the driving habits of individuals who are at different stages of cognitive decline vary." Such insights urge tailored interventions, perhaps gender-sensitive counseling in clinics affiliated with research universities studying neurodegeneration.

Balancing Road Safety and Personal Autonomy: Broader Implications

Retaining primary driver status was common even among dementia cases, emphasizing driving's role in social connectivity. Yet, cessation's fallout is profound: isolation, depression, and healthcare access barriers spike. The study advocates for nuanced assessments beyond static tests, incorporating real-world habit tracking.

In Canada, where seniors comprise 18% of the population (projected 25% by 2040), dementia affects 640,000 lives, doubling by 2030 per Public Health Agency data. Older drivers (80+) number over 1 million, amplifying stakes. This research positions Canadian academic institutions at the forefront, informing policy via evidence from simulators at KITE.

National Guidelines: Navigating Dementia and Licensing in Canada

The Alzheimer Society of Canada stresses early-stage drivability but mandates vigilance. Provincial regulators, guided by the Canadian Medical Association's Driver's Guide, require reassessments every 6-12 months for mild dementia. Physicians must report imminent risks in most provinces (e.g., Ontario's mandatory disclosure law), forwarding to Ministries of Transportation.

• Maintain routines: Familiar routes reduce cognitive load.
• Monitor signs: Delayed reactions, navigation errors, or violations.
• Plan alternatives: Public transit, rideshares, or community shuttles.

Tools like the Driving and Dementia Roadmap aid transitions. Non-disclosure risks insurance invalidation, highlighting ethical dialogues.

UCalgary's Route Complexity Metric: Predicting Preclinical Alzheimer's

Complementing COMPASS-ND, University of Calgary's Healthy City Lab developed a "route complexity metric" using vehicle sensors. Analyzing 111 seniors' GPS data, Kelly Long and Sayeh Bayat found preclinical Alzheimer's patients favored simpler paths—fewer turns, direct routes—years before symptoms. Funded by CIHR, this digital biomarker promises passive monitoring, partnering with Baycrest and Sunnybrook.

Bayat explains, "Dementia is progressive, but early safe driving persists." This geospatial innovation, rooted in Schulich School engineering, could integrate into apps for proactive alerts.

Epidemiological Context: Canada's Aging Roads and Dementia Surge

By 2026, Canada's 85+ cohort exceeds 1 million, many licensed. Dementia crash risk elevates 2-4 fold per studies, though self-regulation mitigates. Projections forecast 128% rise in Ontario dementia drivers by 2030. Multi-province COMPASS-ND data underscores national urgency, with vascular dementia prevalent in rural areas demanding longer drives.

Overcoming Cessation Hurdles: Psychological and Practical Challenges

Voluntary quits preserve dignity but trigger grief akin to loss. Families navigate denial, using empathetic scripts: "We're worried about your safety." Occupational therapists offer on-road evals; simulators predict fitness without risk. For researchers eyeing higher ed careers in geriatrics, these gaps beckon.

Empowering Transitions: Alternatives and Community Supports

Post-cessation, options abound: Paratransit in Toronto/Vancouver, volunteer driver networks, or autonomous vehicle pilots. Brain-healthy habits—exercise, Mediterranean diets—delay decline. Academic-led webinars equip caregivers, fostering resilience.

Horizons in Research: AI, Sensors, and Policy Evolution

Future COMPASS-ND phases eye wearables tracking braking/acceleration. UCalgary's $1M CIHR grant expands to Australia, validating metrics. Policymakers may mandate telematics for seniors, blending safety with equity. Canadian universities drive this, producing experts for academic roles.

Photo by Gene Dizon on Unsplash

Academic Contributions: Elevating Canadian Neurodegeneration Expertise

From U Toronto's KITE to UCalgary's Hotchkiss Institute, universities pioneer solutions. Interdisciplinary teams—psychologists, engineers, epidemiologists—model careers blending research and impact. Explore opportunities at AcademicJobs.ca to join this vital field, supporting Canada's dementia strategy amid 2030 projections.

This study exemplifies how higher education fuels public health advances, ensuring safer roads and sustained independence for aging Canadians.