Subtle changes in older adults' driving habits may provide early warning signs of brain changes and higher dementia risk, according to a preliminary study to be presented at the American Stroke Association's International Stroke Conference 2026. The research followed 220 adults aged 65 and older for over five years, finding that greater white matter damage in the brain was linked to decreased driving, fewer trips, repetitive routes, and more driving errors, particularly in those who later developed dementia.
Researchers used car sensors to track driving behavior including speeding, collisions, hard braking, and hard cornering. Brain imaging studies measured white matter hyperintensities—areas of damage caused by reduced blood flow to brain tissue. Over the follow-up period, 17% of participants developed cognitive impairment, with most later diagnosed with Alzheimer's disease. Among this group, higher white matter hyperintensity burden was linked to greater likelihood of unsafe driving practices and more crashes.
White matter damage in the back part of the brain, which helps process visual information and coordinate movement, was most strongly tied to unsafe driving and 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," said study author Chia-Ling Phuah, M.D., M.M.Sc., of Barrow Neurological Institute in Phoenix.
A significant finding emerged regarding blood pressure management. Participants taking medications to manage high blood pressure, especially angiotensin-converting enzyme (ACE) inhibitors, were less likely to exhibit risky driving compared to those not taking blood pressure medication. This protective effect was observed even when brain scans revealed white matter damage. "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," Phuah noted.
According to the American Heart Association 2026 Heart and Stroke Statistics, about 6.9 million adults 65 years or older in the United States were living with Alzheimer's disease in 2024. 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.
Nada El Husseini, M.D., M.H.Sc., FAHA, chair of the American Heart Association's 2023 scientific statement on cognitive impairment, commented on the findings. "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 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. For business and technology leaders, these findings point to potential applications in automotive safety systems, insurance risk assessment, and healthcare monitoring technologies that could detect early cognitive changes through driving pattern analysis.
Key limitations include the small study size and lack of diversity among participants, as most were white, college-educated adults. 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 was conducted as part of the Driving Real-World In-Vehicle Evaluation System (DRIVES) project based at Washington University in St. Louis.
For the technology industry, these findings highlight opportunities for developing advanced driver monitoring systems that could serve dual purposes in safety and health monitoring. The integration of artificial intelligence and machine learning algorithms could potentially detect subtle pattern changes that human observers might miss, creating new markets at the intersection of automotive technology and healthcare.
