Driving Patterns in Older Adults May Signal Early Brain Changes and Dementia Risk

A study of over 200 adults followed for five years found that greater white matter damage in the brain was linked to decreased driving, fewer trips, repetitive routes and having more driving errors, especially in those who later developed dementia. In contrast, adults ages 65 and older who were taking blood pressure medicines, particularly ACE inhibitors, were less likely to show risky driving behaviors, even when brain damage was present. Subtle changes in everyday driving habits may be early warning signs of brain changes and higher dementia risk, even before traditional memory and thinking symptoms appear, the researchers noted.

Researchers reviewed driving habits for 220 adult volunteers, ages 65 and older, living independently in St. Louis, Missouri. Car sensors were used to track participants’ driving behavior for more than five years. They conducted additional brain imaging studies within the first year of the study to measure changes in the brain’s white matter, specifically white matter hyperintensities. The analysis found that older adults who had more white matter hyperintensities tended to drive less and show sharper declines in their willingness or ability to change driving routes and habits. Over more than five years of follow-up, 17% of participants developed cognitive impairment and most of these individuals were later diagnosed with Alzheimer’s disease.

Among the 17% of participants who developed cognitive impairment, higher white matter hyperintensity burden on brain imaging was linked to a greater likelihood of unsafe driving practices, such as hard braking, and to more crashes. Participants with white matter hyperintensities located in the back of the brain were at even higher risk of crashes than those with changes in other brain areas. Participants taking medications to manage high blood pressure, especially angiotensin-converting enzyme (ACE) inhibitors, were less likely to exhibit risky driving when compared with those who were not taking any blood pressure medication.

Overall, the study’s findings suggest that monitoring driving behavior with commercial in-vehicle data loggers may help identify older adults at higher risk for unsafe driving, loss of independence and subtle cognitive problems. 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. Recent research confirms that blood pressure affects brain health, including cognitive function and dementia, so early treatment is recommended for people diagnosed with high blood pressure to maintain brain health and cognition, according to the 2025 American Heart Association High Blood Pressure Guideline.

Key limitations include a small study size, most participants were white, college-educated adults, so results may not generalize to people from more diverse backgrounds, and medication use was self-reported, which could introduce errors. The next step will be larger studies that include more diverse participants to confirm and extend these findings. The study is a research abstract to be presented at the American Stroke Association’s International Stroke Conference 2026. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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