Cognitive Impairment Screening Test for Senior Drivers

1. Guidance （Pattern D） Cognitive Impairment Screening Test for Senior Drivers National Police Agency Traffic Bureau License Division

2. Introduction

3. It has been shown that the cognitive function for driving declines with aging. • Now, you, the drivers who are aged 75 or older, will be administered Cognitive Impairment Screening Test to examine your cognitive function, when renewing your driving license. • After reading this page, please raise your hand to let us know.

4. Based on the test results, the most appropriate course will be given to each senior driver. • When your test results show cognitive impairment and you have a history of a specific traffic violation (e.g. ignoring a traffic light, ignoring a stop signal etc.), you would be requested by the police to take an additional medical examination. • After reading this page, please raise your hand to let us know.

5. This simple test will take only about 30 minutes. • Instruction of the test is shown on this screen, and we will explain it step by step. Please read the instruction carefully. • You will be notified the test results later. • The test results will be sent to the police. However, this information will not be released to the public. • After reading this page, please raise your hand to let us know.

6. Instruction before starting the Test

7. Please pay attention to the following instruction before starting the Test. • Please put a watch and a cell phone into your bag or your pocket. • Please do not turn pages of your sheets untilthe instruction will be given. • After reading this page, please raise your hand to let us know.

8. Now, please fill out your information in the boxes printed on the front page. • First, the top box is for "Name." Please write your full name. • You cannot use an eraser. • When making a correction, cross out the wrong letters with double line. • Do the same method when you want to make a correction in the following questions. • After reading this page, please raise your hand to let us know.

9. The second box is for "Date of Birth." Please write your date of birth. • The third box is for "Sex." Please circle the number which applies to you. • The last box is for "Frequency of Driving." Please circle the number which applies to you. • That's it for the front page. • Please put your pencil on the desk.

10. Now, we are going to start the test. • First, we explain the test procedure. • After the explanation is done, you will be asked to write the answers. • If you need assistance, please let us know. • After reading this page, please raise your hand.

11. Orientation for Time

12. Now, you are going to start the first test. Please turn to the next page. • You will see the page “ SHEET 1". There are five questions. • Please answer each question. • Please write your answers in the answer boxes next to each question. • Even if you don’t have the correct answer, please write something you believe to be correct. • Please do not leave them blank. • After reading this page, please raise your hand to let us know.

13. Do you have any questions? • If you have some questions, please feel free to ask us. • If you don’t, please take a pencil and raise your hand to let us know. • After theinstruction on this screen, please turn to the next page and start writing the answers.

14. Please turn to the next page and start writing the answers.

15. Time is up. Please put your pencil on the desk.

16. Cued Recall

17. Now you are going to start the second test. You will see some drawings. • There will be drawings of four objects on each sheet. • Later on, you will be asked to write down all the objects you see. • So, please memorize what the objects are drawn on the sheets. • After reading this page, please raise your hand to let us know.

18. Do you have any questions? • If you have any questions, please feel free to ask us. • If you don’t, please raise your hand to let us know.

19. There is a weapon among them. Which one? There is an electric appliance among them. Which one? Please say it aloud. Yes, a sword. Yes, a television (TV) set. You see a piano accordion. You see a sword. You see a television (TV) set. You see legs. There is a musical instrument among them. Which one? There is a part of human body among them. Which one? Yes, a piano accordion. Yes, legs.

20. There is a kitchen appliance among them. Which one? There is vegetables among them. Which one? Yes, a kitchen knife. Yes, green peppers. You see ants. You see a horse. You see green peppers. You see a kitchen knife. There is an animal among them. Which one? There is an insect among them. Which one? Yes, ants. Yes, a horse.

21. There is stationery among them. Which one? There is clothing among them. Which one? Yes, trousers. Yes, writing brushes. You see a helicopter. You see writing brushes. You see trousers. You see a pineapple. There is fruits among them. Which one? There is a means of transportation among them. Which one? Yes, a pineapple. Yes, a helicopter.

22. There is a bird among them. Which one? There is flowers among them. Which one? Yes, a sparrow. Yes, sunflowers. You see a sparrow. You see sunflowers. You see a couch. You see a saw. There is a furniture among them. Which one? There is a carpenters' tool among them. Which one? Yes, a couch. Yes, a saw.

23. How was it? • Later, you will be asked what objects you saw. • So please do not forget what you saw. • After reading this page, please raise your hand to let us know.

24. Now, you will be given another simple test. Please turn to the next page. • You see the page "SHEET 2”. • Next, you will be asked to write the alphabets in reverse order. • For example, when you are asked to write "A, B, C, D, E" in reverse order, you should write "E, D, C, B, A" as you see on the sheet. • After reading this page, please raise your hand to let us know.

25. Do you have any questions? • If you have some questions, please feel free to ask us. • If you don’t, please raise your hand to let us know.

26. Please turn to the next page. There are two rows of five squares, one in the top and the other in the bottom. • First, please write "F, G, H, I, J" in reverse order in the top row of five squares. • After reading this page, please take a pencil and raise your hand to let us know. • After the instruction, please start writing the alphabets.

27. Please start writing the alphabets.

28. Time is up. Please put your pencil on the desk.

29. Next, please write "K, L, M, N, O" in reverse order in the bottom row of five squares. • After reading this page, please take a pencil and raise your hand to let us know. • After the instruction, please start writing the alphabets.

30. Please start writing the alphabets.

31. Time is up. Please put your pencil on the desk.

32. Please turn to the next page. You see the page “SHEET 3”. • A little while ago, you were shown some drawings of the objects. • Do you remember the objects what you saw? • Please write as much as you can recall. You may write them in no special order. • After reading this page, please take a pencil, and raise your hand to let us know.

33. Do you have any questions? • If you have some questions, please feel free to ask us. • If you don’t, please take a pencil and raise your hand to let us know. • After the instruction on the screen, please turn to the next page and start writing the answers.

34. Please turn to the next page and start writing the answers.

35. Time is up. Please put your pencil on the desk.

36. Now, you will have some hints for the objects you saw. Please turn to the next page. You see the page "SHEET 4”. • You will have some hints in the left on the page. • Use the hints and try to recollect the objects what you saw as much as possible. • You can write only one answer for each hint. Do not write more than one. • After reading this page, please raise your hand to let us know.

37. Do you have any questions? If you have some questions, please feel free to ask us. • If you don’t, please take a pencil and raise your hand to let us know. • After the instruction on this screen, please turn to the next page and start writing the answers.

38. Please turn to the next page and start writing the answers.

39. Time is up. Please put your pencil on the desk.

40. Drawing a Clock

41. You will start the next test. Please turn to the next page. You see the page "SHEET 5". • In this test, you will be asked to draw a clock. • First, you are going to draw a clock board. • Draw a large circle, and write all the numbers which should be on the clock. Draw as large as possible. • Later, we will tell you a specific time, and you are asked to draw the hands in the clock which show the time you were told. • After reading this page, please raise your hand to let us know.

42. If you made a mistake, please raise your hand to let us know. We will give you another sheet of paper. • Do you have any questions? If you have some questions, please feel free to ask us. • If you don’t have any questions, please take a pencil and raise your hand to let us know. • After the instruction on this screen, please turn to the next page and draw a clock board.

43. Please turn to the next page and draw a clock board.

44. Time is up. Please put your pencil on the desk.

45. Next, please draw the hands in the clock which show “2:45”. • Please take a pencil. • After reading this page, please raise your hand to let us know. • After the instruction, please start writing the answers.

46. Please start writing the answers.

47. Time is up. Please put your pencil on the desk.

48. The test is over. Thank you for taking the test. We will collect the test sheets. Please remain seated.

49. Scoring the Test Results

50. We will start scoring the test, and we will let you know the scores. • It will take a few minutes to score the tests and to make notifications. • You may take a break, but please be sure to come back. • After reading this page, please raise your hand to let us know.