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Quintas JL, Trindade IOA, Gameiro KSD, Pitta LSR, Camargos EF, Nóbrega OT. Neuropsychological domains and fitness to drive in mild cognitive impairment or Alzheimer's disease. ACCIDENT; ANALYSIS AND PREVENTION 2023; 191:107188. [PMID: 37423139 DOI: 10.1016/j.aap.2023.107188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
Cognitive deficits associated with mild cognitive impairment (MCI) or Alzheimer's disease (AD) can impact driving. This integrative review investigated which cognitive domains were associated with poor driving performance or unfitness to drive in studies with outcomes measured in simulator or on-road driving in patients with MCI or AD. The review was conducted by searching for articles published between 2001 and 2020 in the MEDLINE (via PubMed), EMBASE, and SCOPUS databases. Studies addressing patients with other dementias (e.g., vascular or mixed dementia, Lewy body dementia, Parkinson's disease) were excluded. Of 404 articles initially selected, 17 met the eligibility criteria for this review. Based on the findings of this integrative review, attentional capacity, processing speed, executive functions and visuospatial skills were the functions whose declines were most frequently reported in a context of unsafe driving by older adults with MCI or AD. Reports were remarkably heterogeneous in methodological aspects whereas quite limited in cross-cultural coverage and in sample recruited, what prompts for further trials in the field.
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Affiliation(s)
- Juliana Lima Quintas
- Hospital of the University of Brasilia (HUB), Medical Center for the Aged, Brasília, DF, Brazil
| | | | | | | | | | - Otávio Toledo Nóbrega
- Hospital of the University of Brasilia (HUB), Medical Center for the Aged, Brasília, DF, Brazil; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CR-IUGM), Montreal, QC, Canada.
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Touliou K, Maglaveras N, Bekiaris E. Olfactory discrimination and identification as prognostic markers of fitness-to-drive in older drivers. Sci Rep 2022; 12:21803. [PMID: 36526731 PMCID: PMC9757633 DOI: 10.1038/s41598-022-26262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The necessity for reliable, standardized and validated fitness to drive assessment tools for older drivers have been highlighted and discussed for over three decades. Existing neuropsychological tests of driving performance are focusing mostly on visuo-spatial attention and executive functioning rather than other senses. Over the last decade, olfactory deterioration has been found to be associated with cognitive decline and predicting transition from mild cognitive impairment to dementia. The AGILE fitness to drive battery is standardized for older drivers. In this study it was adapted to include the olfactory Sniff' and Stick's test. The aim was to investigate the value of relevant deficits as predictive markers of driving ability in three driving groups (older drivers with: (a) no impairment (controls), (b) with Mild Cognitive Impairment (MCI) and (c) MCI and other chronic conditions, i.e., comorbidities). So far, no other study has investigated the predictive value of olfactory deficits in driving ability. The findings revealed that discrimination is important for the first year of the examination and as the decline progresses, identification becomes the better olfactory marker. The latter is also evident in the literature. Hence, the results showed that less indicators are required compared to the initial battery. The olfactory markers were dominant over the neuropsychological tests, apart from alertness, for predicting the older driver's fitness to drive regardless of the presence of cognitive impairment and other chronic conditions.
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Driving Ability Evaluation and Rehabilitation for People With Alzheimer's Disease and Related Dementias. Alzheimer Dis Assoc Disord 2022; 36:374-381. [PMID: 35984740 DOI: 10.1097/wad.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
Worldwide, it is estimated that around 50 million older adults have Alzheimer's disease and related dementias (ADRD). Cognitive deficits associated with ADRD may affect a driver's perception and decision-making and potentially cause safety concerns. Despite much research, there lacks a comprehensive cognitive evaluation to determine the driving capability of a person with ADRD and it is unclear what are the most effective training and interventions that help to enhance driving performance for these individuals. The purpose of this article is to conduct a comprehensive literature survey to review and summarize studies of driving performance evaluation and intervention for people with ADRD and discuss perspectives for future studies. Although many studies have investigated the correlations between driving behaviors and cognitive performances for people with ADRD, it remains unclear how driving behaviors and cognitive performances are associated with psychophysiological measures. We discussed the need to develop regular driving evaluation and rehabilitation protocol for people with ADRD. We also highlighted the potential benefit to combine driving tests with psychophysiological measures to assist in characterizing personalized cognitive evaluation in the behavioral evaluation process.
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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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Toepper M, Schulz P, Beblo T, Driessen M. Predicting On-Road Driving Skills, Fitness to Drive, and Prospective Accident Risk in Older Drivers and Drivers with Mild Cognitive Impairment: The Importance of Non-Cognitive Risk Factors. J Alzheimers Dis 2021; 79:401-414. [PMID: 33325384 PMCID: PMC7902978 DOI: 10.3233/jad-200943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND On-road driving behavior can be impaired in older drivers and particularly in drivers with mild cognitive impairment (MCI). OBJECTIVE To determine whether cognitive and non-cognitive risk factors for driving safety may allow an accurate and economic prediction of on-road driving skills, fitness to drive, and prospective accident risk in healthy older drivers and drivers with MCI, we examined a representative combined sample of older drivers with and without MCI (N = 74) in an observational on-road study. In particular, we examined whether non-cognitive risk factors improve predictive accuracy provided by cognitive factors alone. METHODS Multiple and logistic hierarchical regression analyses were utilized to predict different driving outcomes. In all regression models, we included cognitive predictors alone in a first step and added non-cognitive predictors in a second step. RESULTS Results revealed that the combination of cognitive and non-cognitive risk factors significantly predicted driving skills (R2adjusted = 0.30) and fitness to drive (81.2% accuracy) as well as the number (R2adjusted = 0.21) and occurrence (88.3% accuracy) of prospective minor at-fault accidents within the next 12 months. In all analyses, the inclusion of non-cognitive risk factors led to a significant increase of explained variance in the different outcome variables. CONCLUSION Our findings suggest that a combination of the most robust cognitive and non-cognitive risk factors may allow an economic and accurate prediction of on-road driving performance and prospective accident risk in healthy older drivers and drivers with MCI. Therefore, non-cognitive risk factors appear to play an important role.
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Affiliation(s)
- Max Toepper
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Philipp Schulz
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Thomas Beblo
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Martin Driessen
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
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Kim SC, Kong SY, Eom SY, Choe B, Hong SJ. Functional Assessment of Driving Capacity of Older Drivers Compared with Non-older Drivers Using Clinical Evaluations and Driving Simulations. Ann Geriatr Med Res 2021; 25:105-112. [PMID: 33975421 PMCID: PMC8272994 DOI: 10.4235/agmr.21.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/07/2021] [Indexed: 11/08/2022] Open
Abstract
Background This study used various tools, including a self-assessment questionnaire, the Clinical Assessment of Driver-Related Skills (CADReS), and a driving simulation, to discriminate between older and non-older drivers. Methods We evaluated driving habits, driving-related health behaviors, and morbidities using a self-assessment questionnaire and examined visual, motor, and cognitive functions using the CADReS and a vehicle simulator of four junction scenarios that are typical of accidents involving older drivers. The areas under the receiver operating characteristic curves (AUCs) were calculated to compare the age-related discriminating ability of these tools between older (≥65 years) and non-older participants. Results Thirty of the 40 participants (75%) were older. Older drivers were slower than non-older drivers according to the rapid walking pace (8.0 vs. 6.1 seconds), and their cognitive function was poorer based on the trail-making test (117 vs. 51 seconds). While driving on the vehicle simulator, the rate of violating traffic rules was higher and the maximal velocity was slower in the older group than in the non-older group. The AUC values for CADReS and driving simulation outcomes ranged from 0.59 to 0.95, while the rapid walking pace, trail-making test, and velocity of the left turn at an acute junction in the dark showed high discriminatory power (AUC>0.9).Conclusions: The rapid walking pace and trail-making test in CADReS, as well as the driving simulation, were useful tools to discriminate between older and non-older drivers.
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Affiliation(s)
- Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - So Yeon Kong
- Strategic Research, Laerdal Medical, Stavanger, Norway
| | - Sang-Yong Eom
- Department of Preventive Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Office of Public Healthcare Service, Chungbuk National University Hospital, Cheongju, Korea
| | - Byongho Choe
- Korea Transportation Safety Authority, Hwaseong, Korea
| | - Seung Jun Hong
- Department of Smart Mechanical Automotive Engineering, Changwon Moonsung University, Changwon, Korea
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Using Video Replay of Simulated Driving to Estimate Driving Safety and Cognitive Status. SAFETY 2021. [DOI: 10.3390/safety7020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive decline resulting from Dementia of Alzheimer’s Type (DAT) can lead to reduced ability to perform complex daily tasks required for independent living, including driving an automobile. This study explores the ability of untrained observers to classify driving safety using short video clips of simulated driving through intersections; it also examined whether untrained observers could predict whether the driver was cognitively healthy or cognitively impaired. Participants (n = 54) were shown a series of 30 video clips arranged in an online survey and asked to answer questions following each clip regarding the safety of the maneuver and the cognitive status of the driver. Results showed that participants’ subjectively rated DAT drivers as significantly less safe in comparison to control drivers, F (1, 52) = 228.44, p < 0.001. Participant’s classification of DAT drivers and controls was also significantly higher than chance (i.e., >50% correct). Findings provide preliminary support for the development of a clinical decision-making aid using video replay of driving simulator performance in fitness-to-drive assessments for individuals with cognitive impairment.
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Shen Y, Zahoor O, Tan X, Usama M, Brijs T. Assessing Fitness-To-Drive among Older Drivers: A Comparative Analysis of Potential Alternatives to on-Road Driving Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8886. [PMID: 33260453 PMCID: PMC7730871 DOI: 10.3390/ijerph17238886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022]
Abstract
To enable older drivers to maintain mobility without endangering public safety, it is necessary to develop more effective means of assessing their fitness-to-drive as alternatives to an on-road driving test. In this study, a functional ability test, simulated driving test, and on-road driving test were carried out for 136 older drivers. Influencing factors related to fitness-to-drive were selected based on the correlation between the outcome measure of each test and the pass/fail outcome of the on-road driving test. Four potential alternatives combining different tests were considered and three modeling techniques were compared when constructing the fitness-to-drive assessment model for the elderly. As a result, 92 participants completed all of the tests, of which 61 passed the on-road driving test and the remaining 31 failed. A total of seven influencing factors from all types of tests were selected. The best model was trained by the technique of gradient boosted machine using all of the seven factors, generating the highest accuracy of 92.8%, with sensitivity of 0.94 and specificity of 0.90. The proposed fitness-to-drive assessment method is considered an effective alternative to the on-road driving test, and the results offer a valuable reference for those unfit-to-drive older drivers to either adjust their driving behavior or cease driving.
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Affiliation(s)
- Yongjun Shen
- School of Transportation, Southeast University, Nanjing 211189, China; (O.Z.); (X.T.); (M.U.)
- Transportation Research Institute (IMOB), Hasselt University, 3500 Hasselt, Belgium;
| | - Onaira Zahoor
- School of Transportation, Southeast University, Nanjing 211189, China; (O.Z.); (X.T.); (M.U.)
| | - Xu Tan
- School of Transportation, Southeast University, Nanjing 211189, China; (O.Z.); (X.T.); (M.U.)
| | - Muhammad Usama
- School of Transportation, Southeast University, Nanjing 211189, China; (O.Z.); (X.T.); (M.U.)
| | - Tom Brijs
- Transportation Research Institute (IMOB), Hasselt University, 3500 Hasselt, Belgium;
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Economou A, Pavlou D, Beratis I, Andronas N, Papadimitriou E, Papageorgiou SG, Yannis G. Predictors of accidents in people with mild cognitive impairment, mild dementia due to Alzheimer's disease and healthy controls in simulated driving. Int J Geriatr Psychiatry 2020; 35:859-869. [PMID: 32249449 DOI: 10.1002/gps.5306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the driving variables that predict accident probability in mild dementia due to Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy older control drivers in simulated driving. To compare the three groups in mean performance and in frequency of scores exceeding 1.5 SD from the mean. METHODS/DESIGN Participants were 37 drivers with MCI, 16 drivers with AD, and 21 control drivers over the age of 52. Driving measures were derived from four rural driving conditions: moderate traffic without and with distraction and high traffic without and with distraction. The measures were z-transformed based on the performance of 90 control drivers of different ages. Two unexpected incidents occurred per condition, requiring the sudden breaking to avoid an accident. RESULTS Drivers with AD showed significantly lower average speed, speed variability, greater headway distance, headway variability and average reaction time (RT) than control drivers. Drivers with MCI showed significantly lower average speed, greater headway distance and average RT than control drivers in the two conditions of distraction. No differences were found in accident probability. Drivers with AD had more deviant scores than both control drivers and drivers with MCI in most comparisons. Predictors of accident probability were average RT, speed variability and lateral position variability but MCI and AD status were not significant predictors in any of the regression models. CONCLUSIONS Despite significant differences in performance, drivers with MCI and AD did not differ in accident probability from control drivers. An individualized approach of examining individual driving performance is recommended.
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Affiliation(s)
- Alexandra Economou
- Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimosthenis Pavlou
- School of Civil Engineering, Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Ion Beratis
- 1st University Department of Neurology, Eginiteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Andronas
- Cognitive Disorders/Dementia Unit, 2nd University Department of Neurology, ATTIKON University General Hospital at Haidari, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleonora Papadimitriou
- Delft University of Technology, Faculty of Technology, Policy and Management, Delft, The Netherlands
| | - Sokratis G Papageorgiou
- 1st University Department of Neurology, Eginiteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
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Abstract
Dementia is a risk factor for unsafe driving. Therefore, an assessment strategy has recently been developed for the prediction of fitness to drive in patients with the Alzheimer disease (AD). The aim of this study was to investigate whether this strategy is also predictive of fitness to drive in patients with non-AD dementia, that is, vascular dementia, frontotemporal dementia, and dementia with Lewy bodies. Predictors were derived from 3 types of assessment: clinical interviews, neuropsychological tests, and driving simulator rides. The criterion was the pass-fail outcome of an official on-road driving assessment. About half of the patients with non-AD dementia (n=34) failed the on-road driving assessment. Neuropsychological assessment [area under the curve (AUC)=0.786] was significantly predictive of fitness to drive in patients with non-AD dementia, however, clinical interviews (AUC=0.559) and driving simulator rides (AUC=0.404) were not. The fitness-to-drive assessment strategy with the 3 types of assessment combined (AUC=0.635) was not found to significantly predict fitness to drive in non-AD dementia. Different types of dementia require different measures and assessment strategies.
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Toepper M, Falkenstein M. Driving Fitness in Different Forms of Dementia: An Update. J Am Geriatr Soc 2019; 67:2186-2192. [PMID: 31386780 DOI: 10.1111/jgs.16077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Most forms of dementia are associated with progressive cognitive and noncognitive impairments that can severely affect fitness to drive. Whether safe driving is still possible in the single case, however, is often difficult to decide and may be dependent on both severity and type of the respective dementia syndrome. Particularly in early disease stages, Alzheimer disease dementia (ADD) and different types of non-Alzheimer dementias, such as vascular dementia (VaD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and Parkinson disease dementia (PDD), might differentially affect fitness to drive. DESIGN To examine the effects of severity and type of dementia on driving fitness, we conducted a systematic review with qualitative narrative synthesis, involving different driving outcomes in different forms and stages of dementia. SETTING Literature research included MEDLINE and PsycINFO databases with a focus on the most relevant and recent publications on the topic. PARTICIPANTS The population of interest included older drivers in different stages of ADD and different forms of non-Alzheimer dementias (VaD, FTD, DLB, and PDD). MEASUREMENTS Narrative description of driving outcomes in the population of interest. RESULTS Overall, previous studies suggest that driving fitness is severely impaired in moderate and severe dementia, irrespective of the type of dementia. In milder disease stages, fitness to drive appears to be more severely impaired in non-Alzheimer dementias than in ADD, since the non-Alzheimer syndromes are not only associated with driving-relevant cognitive but noncognitive risk factors, such as behavioral or motor symptoms. CONCLUSIONS Based on these findings, practical recommendations are presented, including a risk evaluation for driving safety, depending on severity and type of different dementia syndromes. J Am Geriatr Soc 67:2186-2192, 2019.
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Affiliation(s)
- Max Toepper
- Evangelisches Klinikum Bethel, Research Division, Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany.,Evangelisches Klinikum Bethel, Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany
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Rashid R, Standen P, Carpenter H, Radford K. Systematic review and meta-analysis of association between cognitive tests and on-road driving ability in people with dementia. Neuropsychol Rehabil 2019; 30:1720-1761. [DOI: 10.1080/09602011.2019.1603112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roshe Rashid
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Penny Standen
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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13
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Ungewiss J, Kübler T, Sippel K, Aehling K, Heister M, Rosenstiel W, Kasneci E, Papageorgiou E. Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss. Graefes Arch Clin Exp Ophthalmol 2018; 256:2429-2435. [PMID: 30251198 DOI: 10.1007/s00417-018-4148-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE On-road testing is considered the standard for assessment of driving performance; however, it lacks standardization. In contrast, driving simulators provide controlled experimental settings in a virtual reality environment. This study compares both testing conditions in patients with binocular visual field defects due to bilateral glaucomatous optic neuropathy or due to retro-chiasmal visual pathway lesions. METHODS Ten glaucoma patients (PG), ten patients with homonymous visual field defects (PH), and 20 age- and gender-matched ophthalmologically normal control subjects (CG and CH, respectively) participated in a 40-min on-road driving task using a dual brake vehicle. A subset of this sample (8 PG, 8 PH, 8 CG, and 7 CH) underwent a subsequent driving simulator test of similar duration. For both settings, pass/fail rates were assessed by a masked driving instructor. RESULTS For on-road driving, hemianopia patients (PH) and glaucoma patients (PG) showed worse performance than their controls (CH and CG groups): PH 40%, CH 30%, PG 60%, CG 0%, failure rate. Similar results were obtained for the driving simulator test: PH 50%, CH 29%, PG 38%, CG 0%, failure rate. Twenty-four out of 31 participants (77%) showed concordant results with regard to pass/fail under both test conditions (p > 0.05; McNemar test). CONCLUSIONS Driving simulator testing leads to results comparable to on-road driving, in terms of pass/fail rates in subjects with binocular (glaucomatous or retro-chiasmal lesion-induced) visual field defects. Driving simulator testing seems to be a well-standardized method, appropriate for assessment of driving performance in individuals with binocular visual field loss.
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Affiliation(s)
- Judith Ungewiss
- Study course Ophthalmic Optics, University of Applied Sciences, Aalen, Germany
| | - Thomas Kübler
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Katrin Sippel
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Kathrin Aehling
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Martin Heister
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Enkelejda Kasneci
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, 41222, Larissa, Greece.
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14
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Aiding medical professionals in fitness-to-drive screenings for elderly drivers: development of an office-based screening tool. Int Psychogeriatr 2018; 30:1211-1225. [PMID: 29223185 DOI: 10.1017/s1041610217002678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTBackground:Elderly drivers are an increasing group in society. Previous research has found that functional and cognitive abilities are more important for driving abilities than biological age. In an attempt to conserve independent mobility for elderly drivers, many researchers have focused on elderly drivers diagnosed with cognitive decline (mild cognitive impairment or mild Dementia). This study is the first to focus on elderly drivers with cognitive complaints or suspected of diminished fitness to drive by an (in)formal caregiver as an at-risk group. METHODS The main objective of this study was to develop a fitness to drive screening tool for elderly drivers to be used in a doctor's office. Furthermore, this study investigated the additional value of driving simulator tests in the assessment of fitness to drive. Both screenings (functional abilities and driving simulator test) were benchmarked against the official Belgian fitness to drive licensing procedure. RESULTS One-hundred thirty-six elderly drivers participated in a functional abilities screening, a driving simulator assessment and an on-road driving test. Sixty-five percent of the sample was considered fit to drive. Visual acuity, physical flexibility, and knowledge of road signs were found to be the best predictive set of tests for the on-road fitness to drive outcome. A performance based driving simulator assessment increased predictive accuracy significantly. CONCLUSION The proposed screening procedure saves part of the at-risk elderly driver population from stressful and costly on-road driving evaluations. This procedure provides more information of an individual driver's specific driving parameters. This opens doors for personalized older driver training to maintain independent mobility in later life.
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15
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Kereszty ÉM, Julesz M. Medical fitness to drive in the EU with special reference to the age factor. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Versijpt J, Tant M, Beyer I, Bier JC, Cras P, De Deyn PP, De Wit P, Deryck O, Hanseeuw B, Lambert M, Lemper JC, Mormont E, Petrovic M, Picard G, Salmon E, Segers K, Sieben A, Thiery E, Tournoy J, Vandewoude M, Ventura M, Verschraegen J, Engelborghs S, Goffin T, Deneyer M, Ivanoiu A. Alzheimer's disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association. Acta Neurol Belg 2017; 117:811-819. [PMID: 28983881 DOI: 10.1007/s13760-017-0840-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
Alzheimer's disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.
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