Background

What is the SIMARD MD?
The SIMARD MD is a valid and reliable screening tool for identifying cognitively impaired drivers whose driving skills may have declined to an unsafe level. [1] 'SIMARD MD' is an acronym for 'Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers a Modification of the DemTect'. It is called a modification of the DemTect (MD) because it uses a subset of the items from that screening tool. [2]
Who can use the SIMARD MD?
The SIMARD MD can be used by health care professionals and driver licensing agency personnel. It can help them identify cognitively impaired drivers whose driving skills may have declined to an unsafe level.
Do I have to pay to use the SIMARD MD?
The SIMARD MD is a non-proprietary tool. That means it can be used for free.
How can the SIMARD MD be used to address the driving issue?
As a screening tool, the SIMARD MD should be administered as part of a driver's medical, particularly if the driver presents with one or more chronic medical conditions that may impair cognition. A list of these conditions can be found at the MARD Frequently Asked Questions page Within the clinical setting, it is appropriate to use the SIMARD MD as part of a chronic disease management protocol or as a routine component of an annual medical, especially for those patients aged 70 years and older. Licensing authorities can routinely use the SIMARD MD at license renewals or request the SIMARD MD be administered as part of a driver fitness review process. More details on the SIMARD MD are available in this short video called An Introduction to the SIMARD MD.
What does the SIMARD MD test consist of?
The SIMARD MD consists of four short paper and pencil based tasks. Those tasks assess everyday cognitive abilities that are predictive of driving performance.
How long does it take to administer and score the test?

The SIMARD MD is easy to administer and score. The paper and pencil based test takes about 5 minutes to administer. The test can be scored in 1-2 minutes with no special training or clinical expertise needed.

To help you become familiar with the SIMARD MD, please watch the training video Administration of the SIMARD MD available through the SIMARD MD Access page.

What does the SIMARD MD score mean?

The SIMARD MD can identify drivers with cognitive impairment who may no longer be safe to drive. Scores on the SIMARD MD identify three groups of drivers:

  1. Drivers who have a high probability of failing a driving evaluation.
  2. Drivers with a high probability of passing a driving evaluation.
  3. Drivers who need a driving evaluation to determine driving competency.

Additional information on scoring the SIMARD MD is provided in the short video Scoring the SIMARD MD available through the SIMARD MD Access page.

How does the SIMARD MD compare to the Mini-Mental Status Examination (MMSE) for predictions about driving competency?
The MMSE [3] is one of the most commonly used tools to assist in the identification of cognitively impaired drivers. Although the MMSE is a good screen for dementia, it also is frequently used in the clinical setting for making decisions about driving competency. However, the MMSE was not designed for that purpose. There now is a considerable amount of research that indicates that the MMSE is of questionable utility for identifying cognitively impaired drivers whose driving has declined to an unsafe level. [4] [5] The predictive properties of the SIMARD MD were compared to those of the MMSE. Results indicated that the SIMARD MD was superior in identifying drivers who would likely fail an on-road evaluation and also in identifying those drivers who would likely pass an on-road evaluation.
How can the SIMARD MD improve public safety?

Cognitively impaired drivers are a public health challenge. The SIMARD MD represents a significant advance in addressing this problem because health care professionals and driver licensing authorities can use the SIMARD MD to objectively identify drivers with cognitive impairment whose driving skills may have declined to an unsafe level. The SIMARD MD:

- Is a brief, easy to administer, paper and pencil test that can be scored in 1-2 minutes with no special training or clinical expertise needed. Was developed and validated against actual driving performance.

- Has scientifically based cut-points that allow for immediate decision making in the clinical setting.

- Increases confidence about driving decisions.

For an overall summary on the SIMARD MD, please access the Informational Videos on the SIMARD MD.

How can I get a copy of the published article on the SIMARD MD?
Please visit our SIMARD MD Publications page for free access to the published article on the SIMARD MD.
What formats (e.g., printable, downloadable, etc.) is the SIMARD MD available in? Can my clinic put it into our EMR?
The SIMARD MD is available as a printable PDF document, an interactive online document that can be used on the computer, and as a set of files can be downloaded to your computer. For assistance with adding the SIMARD MD to your EMR, please contact us at mard@ualberta.ca.
References
  1. Dobbs, B. M., & Schopflocher, D. (2010). The introduction of a new screening tool for the identification of cognitively impaired medically at-risk drivers: The SIMARD A Modification of the DemTect. Journal of Primary Care and Community Health, 1(2), 119-127.
  2. Kalbe, E., Kessler, J., Calabrese, P., Smith, R., Passmore, A. P., Brand, M., & Bullock, R. (2004). A new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. International Journal of Geriatric Psychiatry, 19(2), 136-143.
  3. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
  4. Marottoli, R. A., Richardson, E. D., Stowe, M. H., Miller, E. G., Brass, L. M., Cooney, L. M. Jr., & Tinetti, M. E. (1998). Development of a test battery to identify older drivers at risk for self-reported adverse driving events. Journal of the American Geriatrics Society, 46(5), 562-568.
  5. Fitten, L. J., Perryman, K. M., Wilkinson, C. J., Little, R. J., Burns, M. M., Pachana, N., . . . Ganzell, S. (1995). Alzheimer and vascular dementias and driving: A prospective road andlaboratory study. The Journal of the American Medical Association, 273(17), 1360-1365.
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For More Information

For more information about the SIMARD MD, please see the Frequently Asked Questions page.

For further inquiries, please contact us at mard@ualberta.ca.