In the article, Cognitive Status Changes Based on Time of Day In Nursing Home Patients With and Without Dementia, disruptions of the circadian rhythm and its effects on cognition are explored in patients with and without dementia. The study results indicated that the effects of time-of-day on administration of Mini-Mental State Examinations in nursing home patients with dementia was such that men and women perform equally in the morning, while women performed marginally worse in the afternoon. These results were especially pronounced for areas of orientation and immediate recall. On the contrary, men performed significantly better in the afternoon than they did in the morning. However, given the small number of study participants (38), the results are not significant enough to recommend any change in time of day assessments for patients with dementia.

The 4Cs (Crash History, Family Concerns, Clinical Condition, and Cognitive Functions): A Screening Tool for the Evaluation of the At-Risk Driver provides preliminary data, which seeks to accurately identify at-risk drivers, while also providing a practical means for physicians to do so. With the growing aging population, and the fact that many physicians are uncertain as to whether they have the expertise or time to make correct judgments about patients' driving competence, such a measure is necessary.

The 4Cs assessment includes a measure of crash history, family concerns, clinical condition, and cognitive functions. Information regarding each domain is obtained during a standard medical interview, either through direct observation, or on the basis of questions posed by the clinician. It does not require specialized training, and it is relatively quick to administer.

Of the participants in the study, over half had a neurodegenerative disease such as Alzheimer's. The domains most strongly associated with road test outcome were cognitive function and family concerns. Scores of 9 or greater on the 4Cs correctly identified 84% of participants who were at risk for poor road test performance based on a Drive Wise driving simulation. While the findings provide only preliminary data, it is hoped that this interview based screening tool may offer the physician a starting point for having an important discussion about driving with their patients.