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Chang JH, Bhatti D, Uc EY, Rizzo M, Merickel J. Digital driving data can track driving exposure and quality of life in Parkinson's disease. TRAFFIC INJURY PREVENTION 2023; 25:20-26. [PMID: 37722820 DOI: 10.1080/15389588.2023.2247110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/08/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) impairs motor and non-motor functions. Driver strategies to compensate for impairments, like avoiding driving in risky environments, may reduce on-road risk at the cost of decreasing driver mobility, independence, and quality of life (QoL). It is unclear how PD symptoms link to driving risk exposure, strategies, and QoL. We assessed associations between PD symptoms and driving exposure (1) overall, (2) in risky driving environments, and (3) in relationship to QoL. METHODS Twenty-eight drivers with idiopathic PD were assessed using the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and RAND 36-Item Short Form Health Survey (SF-36). Real-world driving was monitored for 1 month. Overall driving exposure (miles driven) and risky driving exposure (miles driven in higher risk driving environments) were assessed across PD symptom severity. High traffic, night, and interstate roads were considered risky environments. RESULTS 18,642 miles (30,001 km) driven were collected. Drivers with PD with worse motor symptoms (MDS-UPDRS Part III) drove more overall (b = 0.17, P < .001) but less in risky environments (night: b = -0.35, P < .001; interstate roads: b = -0.23, P < .001; high traffic: b = -0.14, P < .001). Worse non-motor daily activities symptoms (MDS-UPDRS Part I) did not affect overall driving exposure (b = -0.05, P = .43) but did affect risky driving exposure. Worse non-motor daily activities increased risk exposure to interstate (b = 0.36, P < .001) and high traffic (b = 0.09, P = .03) roads while reducing nighttime risk exposure (b = -0.15, P = .01). Daily activity impacts from motor symptoms (MDS-UPDRS Part II) did not affect distance driven. Reduced driving exposure (number of drives per day) was associated with worse physical health-related QoL (b = 2.87, P = .04). CONCLUSIONS Results provide pilot data revealing specific PD symptom impacts on driving risk exposure and QoL. Drivers with worse non-motor impairments may have greater risk exposure. In contrast, drivers with worse motor impairments may have reduced driver risk exposure. Reduced driving exposure may worsen physical health-related QoL. Results show promise for using driving to inform clinical care.
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Affiliation(s)
- Jun Ha Chang
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Danish Bhatti
- Internal Medicine, University of Central Florida, Orange County, Florida
| | - Ergun Y Uc
- Department of Neurology, University of Iowa, Iowa City, Iowa
- Neurology Service, Iowa City Virginia Medical Center, Iowa City, Iowa
| | - Matthew Rizzo
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jennifer Merickel
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
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Giang WC, Zheng H, Gibson B, Patel B, Ramirez-Zamora A, Winter S, Jeghers M, Li Y, Classen S. Does in-vehicle automation help individuals with Parkinson's disease? A preliminary analysis. Front Neurol 2023; 14:1225751. [PMID: 37900602 PMCID: PMC10603248 DOI: 10.3389/fneur.2023.1225751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction PD is a progressive neurodegenerative disorder that affects, according to the ICF, body systems (cognitive, visual, and motor), and functions (e.g., decreased executive functions, decreased visual acuity, impaired contrast sensitivity, decreased coordination)-all which impact driving performance, an instrumental activity of daily living in the domain of "Activity" and "Participation" according to the ICF. Although there is strong evidence of impaired driving performance in PD, few studies have explored the real-world benefits of in-vehicle automation technologies, such as in-vehicle information systems (IVIS) and advanced driver assistance systems (ADAS), for drivers with PD. These technologies hold potential to alleviate driving impairments, reduce errors, and improve overall performance, allowing individuals with PD to maintain their mobility and independence more safely and for longer periods. This preliminary study aimed to fill the gap in the literature by examining the impact of IVIS and ADAS on driving safety, as indicated by the number of driving errors made by people with PD in an on-road study. Methods Forty-five adults with diagnosed PD drove a 2019 Toyota Camry equipped with IVIS and ADAS features (Toyota Safety Sense 2.0) on a route containing highway and suburban roads. Participants drove half of the route with the IVIS and ADAS systems activated and the other half with the systems deactivated. Results The results suggest that systems that assume control of the driving task, such as adaptive cruise control, were most effective in reducing driving errors. Furthermore, individual differences in cognitive abilities, particularly memory, were significantly correlated with the total number of driving errors when the systems were deactivated, but no significant correlations were present when the systems were activated. Physical capability factors, such as rigidity and bradykinesia, were not significantly correlated with driving error. Discussion Taken together, these results show that in-vehicle driver automation systems can benefit drivers with PD and diminish the impact of individual differences in driver cognitive ability.
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Affiliation(s)
- Wayne C.W. Giang
- Department of Industrial and Systems Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
| | - Haolan Zheng
- Department of Industrial and Systems Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
| | - Beth Gibson
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Sandra Winter
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Mary Jeghers
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Yuan Li
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Sherrilene Classen
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
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Makhoul K, Jankovic J. Driving Impairment in Movement Disorders. Mov Disord Clin Pract 2023; 10:369-381. [PMID: 36949799 PMCID: PMC10026316 DOI: 10.1002/mdc3.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/29/2023] Open
Abstract
Background Driving may be adversely affected by any movement disorder, but has been mostly studied in Parkinson's disease (PD). Few studies have addressed driving impairment in patients with Huntington's disease (HD); driving in other movement disorders such as dystonia, blepharospasm and Tourette syndrome (TS) has not been adequately evaluated. Objectives The aim of this review is to summarize the findings of driving impairment in movement disorders and evaluate the usefulness of clinical tools in guiding clinicians whether to refer patients for driving assessment. Methods A review of literature was performed on PubMed and articles on driving and movement disorders were identified using a Boolean phrase. Results We were able to identify 66 articles that fulfilled the target subject: impairment of driving in PD, cervical dystonia, blepharospasm, HD and TS. We also included articles discussing the role of driving rehabilitation in patients with movement disorders. Conclusions Driving is often impaired in patients with PD and other movement disorders not only due to motor symptoms but also because of cognitive and behavioral co-morbidities. Certain screening tools may be helpful in guiding the clinician in referring the patients for driving assessment.
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Affiliation(s)
- Karim Makhoul
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTexasUSA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTexasUSA
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Krasniuk S, Mychael D, Crizzle AM. Driving Errors Predicting Pass/Fail On-Road Assessment Outcomes Among Cognitively Impaired Older Drivers. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:144-153. [PMID: 35337241 PMCID: PMC9729977 DOI: 10.1177/15394492221076494] [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] [Indexed: 12/29/2022]
Abstract
Older drivers with cognitive impairment (CI)/dementia make significantly more driving errors than healthy controls; however, whether driving errors are predictive of pass/fail outcomes in older drivers with CI/dementia are unclear. This study determined the driving errors that predicted failing an on-road assessment in drivers with CI. We retrospectively collected comprehensive driving evaluation data of 80 participants (76.1 ± 9.3 years) from an Ontario driving assessment center. Adjustment to stimuli (area under the curve [AUC] = 0.88), lane maintenance (AUC = 0.84), and speed regulation errors (AUC = 0.85) strongly predicted pass/fail outcomes. Worse performance on the Trails B (time) and Useful Field of View® (Subtest 2, Subtest 3, and risk index) were significantly correlated with adjustment to stimuli (p < .05), lane maintenance (p < .05), and speed regulation errors (p < .05). Adjustment to stimuli, lane maintenance, and speed regulation errors may be critical indicators of failing an on-road assessment in older drivers with CI. Prioritizing these errors may help identify at-risk drivers.
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Affiliation(s)
| | | | - Alexander M. Crizzle
- University of Saskatchewan, Saskatoon, Canada,Alexander M. Crizzle, Associate Professor and Director of the Driving Research & Simulation Laboratory, School of Public Health, University of Saskatchewan, 104 Clinic Road, Saskatoon, Saskatchewan, Canada S7N 2Z4.
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Classen S, Li Y, Giang W, Winter S, Wei J, Patel B, Jeghers M, Gibson B, Rogers J, Ramirez-Zamora A. RCT protocol for driving performance in people with Parkinson's using autonomous in-vehicle technologies. Contemp Clin Trials Commun 2022; 28:100954. [PMID: 35812823 PMCID: PMC9256542 DOI: 10.1016/j.conctc.2022.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Driving is an essential facilitator of independence, community participation, and quality of life. Drivers with Parkinson's Disease (PD) make more driving errors and fail on-road evaluations more than healthy controls. In-vehicle technologies may mitigate PD-related driving impairments and associated driving errors. Establishing a rigorous study protocol will increase the internal validity and the transparency of the scientific work. Methods We present a protocol to assess the efficacy of autonomous in-vehicle technologies (Level 1) on the driving performance of drivers with PD via a randomized crossover design with random allocation. Drivers with a PD diagnosis based on established clinical criteria (N = 105), referred by neurologists, are exposed to two driving conditions (technology activated or not) on a standardized road course as they drove a 2019 Toyota Camry. The researchers collected demographic, clinical, on-road data observational and kinematic, and video data to understand several primary outcome variables, i.e., number of speeding, lane maintenance, signaling, and total driving errors. Discussion The protocol may enhance participant adherence, decrease attrition, provide early and accurate identification of eligible participants, ensure data integrity, and improve the study flow. One limitation is that the protocol may change due to unforeseen circumstances and assumptions upon implementation. A strength is that the protocol ensures the study team executes the planned research in a systematic and consistent way. Following, adapting, and refining the protocol will enhance the scientific investigation to quantify the nuances of driving among those with PD in the era of automated in-vehicle technologies. Trial registration ClinicalTrials.gov NCT04660500.
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Fründt O, Fadhel M, Heesen C, Seddiq Zai S, Gerloff C, Vettorazzi E, Pöttgen J, Buhmann C. Do Impulse Control Disorders Impair Car Driving Performance in Patients with Parkinson's Disease? JOURNAL OF PARKINSON'S DISEASE 2022; 12:2261-2275. [PMID: 36120790 DOI: 10.3233/jpd-223420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Based on data regarding the prevalence of Parkinson's disease (PD), the prevalence of impulsive control disorders (ICD) in PD, and the percentage of PD patients driving a car, it has to be assumed that at least 50,000 PD patients with ICD in Germany actively drive a car. However, these patients might be at risk for unsafe driving due to ICD-related dysfunctions such as failure to resist an impulse or temptation, to control an act or other altered neurobehavioral processes. OBJECTIVE This study determines the influence of ICD on driving ability in PD. METHODS We prospectively compared driving simulator performance of 23 PD patients with and 23 matched patients without ICD. ICD had to be socially compensated and presence was defined clinically for primary and questionnaire-based (QUIP-RS) for post-hoc analyses. Furthermore, between-group comparisons of driving-relevant neuropsychological tests were executed. RESULTS Except from a lower blinking frequency when changing lanes, overall driving safety of patients with ICD did not differ significantly from those without-regardless of the clinical or QUIP-RS-based ICD definition. ICD severity did not correlate with driving performance, but the latter correlated significantly with mean reaction times and certain neuropsychiatric tests (MoCA, TMT-A, TAP-M "flexibility" and DBQ "error"). CONCLUSION Clinically compensated ICD does not seem to impair driving safety in PD patients. Rather, cognitive and attentional deficits appear to be clinical markers for driving uncertainty.
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Affiliation(s)
- Odette Fründt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Mazen Fadhel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susan Seddiq Zai
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Center for Experimental Medicine & Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Pöttgen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Driving is impaired in most patients with Parkinson disease because of motor, cognitive, and visual dysfunction. Driving impairments in Parkinson disease may increase the risk of crashes and result in early driving cessation with loss of independence. Drivers with Parkinson disease should undergo comprehensive evaluations to determine fitness to drive with periodic follow-up evaluations as needed. Research in rehabilitation of driving and automation to maintain independence of patients with Parkinson disease is in progress.
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Affiliation(s)
- Maud Ranchet
- Laboratoire Ergonomie Sciences Cognitives pour les Transports (LESCOT), IFSTTAR (Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux), 25, Avenue François Mitterrand, Case 24, Cité des Mobilités, Lyon, Bron F-69675, France
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, Kansas University, KU Medical Center, 3901 Rainbow Boulevard/MS2002, Kansas City, KS 66160, USA
| | - Ergun Y Uc
- Department of Neurology, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA; Neurology Service, Veterans Affairs Medical Center, 601 Highway 6 W, Iowa City, IA 52246, USA.
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Fuermaier AB, Piersma D, de Waard D, Davidse RJ, de Groot J, Doumen MJ, Bredewoud RA, Claesen R, Lemstra AW, Scheltens P, Vermeeren A, Ponds R, Verhey F, De Deyn PP, Brouwer WH, Tucha O. Driving Difficulties Among Patients with Alzheimer’s Disease and Other Neurodegenerative Disorders. J Alzheimers Dis 2019; 69:1019-1030. [DOI: 10.3233/jad-181095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anselm B.M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | | | - Jolieke de Groot
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | - Michelle J.A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | | | - René Claesen
- CBR Dutch driving license authority, Rijswijk, The Netherlands
| | - Afina W. Lemstra
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Neurology and Alzheimer Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Classen S, Brumback B, Crawford K, Jenniex S. Visual Attention Cut Points for Driver Fitness in Parkinson's Disease. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:257-265. [PMID: 30907280 DOI: 10.1177/1539449219836689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study determined whether the Useful Field of View™ Risk Index (UFOV RI) adds value as a predictor of on-road outcomes in drivers with Parkinson's disease (PD) when considered with age, gender, and disease severity and compared with community-dwelling older drivers (Controls). A total of 101 PD drivers and 138 Controls underwent a comprehensive driving evaluation, including an on-road assessment. Logistic regression analyses determined the associations of age, gender, visual attention, and disease severity to on-road outcomes. Receiver operating characteristic curve analyses determined the optimal UFOV RI cut points to predict on-road outcomes. Above adding age and gender, the UFOV RI alone predicted on-road outcomes in PD, while the UFOV RI and age predicted on-road outcomes in Controls. Regardless of disease severity, visual attention was more impaired in PD than in Controls. The UFOV RI cut point of 3 provided the fewest misclassifications (n = 25) in PD. The UFOV RI is a valid screening predictor of on-road outcomes across PD drivers of different disease severity, but has moderate sensitivity and specificity.
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Affiliation(s)
- Sherrilene Classen
- University of Florida, Gainesville, USA.,University of Western Ontario, London, Canada
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Ando R, Iwaki H, Tsujii T, Nagai M, Nishikawa N, Yabe H, Aiba I, Hasegawa K, Tsuboi Y, Aoki M, Nakashima K, Nomoto M. The Clinical Findings Useful for Driving Safety Advice for Parkinson's Disease Patients. Intern Med 2018; 57:1977-1982. [PMID: 29491315 PMCID: PMC6096020 DOI: 10.2169/internalmedicine.9653-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective We conducted a study to obtain information that could be used to provide Parkinson's disease (PD) patients with appropriate advice on safe driving. Methods Consecutive PD patients who visited our office were studied. Among these patients, those who had experienced driving after being diagnosed with PD were interviewed by neurologists and a trained nurse to investigate their previous car accidents, motor function, cognitive function, sleepiness, levodopa equivalent dose (LED), and emotional dysregulation. The rates of major car accidents before and after the onset of PD were compared. Results Fifteen patients had experienced a major car accident resulting in human injury or serious property damage since the onset of PD. When the rates of major car accidents before and after the onset of PD were compared, the ratio was 4.3 [95% confidence interval (CI) 1.9-9.7]. The incidence of accidents after the onset of PD was correlated with age, disease duration, LED, the cognitive function Mini-Mental Scale Examination (MMSE), Japanese translation of the Montreal Cognitive Assessment (MoCA-J), but not the motor symptom score [Unified Pankinson's disease rating scale (UPDRS) part III at the time of the study]. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) score was also higher in patients with major car accidents. Conclusion The severity of symptoms (Hoehn-Yahr classification), cognitive function, and disease duration were expected to be risk factors for car accidents. However, the motor symptom score (UPDRS part III) was not associated with the incidence of major car accidents. In addition to a low cognitive function and the severity of symptoms, the QUIP score might be an independent factor that can be referenced when advising PD patients to refrain from driving.
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Affiliation(s)
- Rina Ando
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Hirotaka Iwaki
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, USA
| | - Tomoaki Tsujii
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Masahiro Nagai
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Noriko Nishikawa
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Hayato Yabe
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
| | - Ikuko Aiba
- Department of Neurology, Higashi Nagoya Hospital, Japan
| | - Kazuko Hasegawa
- Department of Neurology, Sagamihara National Hospital, Japan
| | | | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Japan
| | - Kenji Nakashima
- Department of Neurology, Tottori University Faculty of Medicine, Japan
| | - Masahiro Nomoto
- Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
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Alvarez L, Classen S. Driving with Parkinson's disease: Cut points for clinical predictors of on-road outcomes: La conduite automobile et la maladie de Parkinson : Points de découpage pour les prédicteurs clinique des résultats des épreuves sur route. The Canadian Journal of Occupational Therapy 2018; 85:232-241. [PMID: 29635922 DOI: 10.1177/0008417418755458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a common neurodegenerative disorder that impacts a person's fitness to drive. Practitioners require a sensitive and predictive battery of clinical tests to identify at-risk drivers. PURPOSE This study aimed to identify clinical predictors and their optimal cut points, sensitivity, specificity, and predictive values of on-road outcomes in drivers with PD. METHOD Participants ( N = 101) underwent a comprehensive driving evaluation. We identified predictors of pass/fail outcomes through logistic regression and computed optimal cut points through receiver operating characteristic curves and corresponding Youden indexes. FINDINGS The Trail Making Test Part B (Trails B; sensitivity = .89, specificity = .74; positive predictive value [PPV] = .71; negative predictive value [NPV] = .91) and contrast sensitivity (sensitivity = .82, specificity = .63; PPV = .61; NPV = .84) emerged as significant predictors. The optimal cut point for the Trails B was 108 s (area under the curve = .86). IMPLICATIONS Occupational therapists can benefit from implementing Trails B and contrast sensitivity screening as part of in-office screening of potentially at-risk drivers with PD.
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Uc EY, Rizzo M, O'Shea AMJ, Anderson SW, Dawson JD. Longitudinal decline of driving safety in Parkinson disease. Neurology 2017; 89:1951-1958. [PMID: 29021353 DOI: 10.1212/wnl.0000000000004629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/23/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To longitudinally assess and predict on-road driving safety in Parkinson disease (PD). METHODS Drivers with PD (n = 67) and healthy controls (n = 110) drove a standardized route in an instrumented vehicle and were invited to return 2 years later. A professional driving expert reviewed drive data and videos to score safety errors. RESULTS At baseline, drivers with PD performed worse on visual, cognitive, and motor tests, and committed more road safety errors compared to controls (median PD 38.0 vs controls 30.5; p < 0.001). A smaller proportion of drivers with PD returned for repeat testing (42.8% vs 62.7%; p < 0.01). At baseline, returnees with PD made fewer errors than nonreturnees with PD (median 34.5 vs 40.0; p < 0.05) and performed similar to control returnees (median 33). Baseline global cognitive performance of returnees with PD was better than that of nonreturnees with PD, but worse than for control returnees (p < 0.05). After 2 years, returnees with PD showed greater cognitive decline and larger increase in error counts than control returnees (median increase PD 13.5 vs controls 3.0; p < 0.001). Driving error count increase in the returnees with PD was predicted by greater error count and worse visual acuity at baseline, and by greater interval worsening of global cognition, Unified Parkinson's Disease Rating Scale activities of daily living score, executive functions, visual processing speed, and attention. CONCLUSIONS Despite drop out of the more impaired drivers within the PD cohort, returning drivers with PD, who drove like controls without PD at baseline, showed many more driving safety errors than controls after 2 years. Driving decline in PD was predicted by baseline driving performance and deterioration of cognitive, visual, and functional abnormalities on follow-up.
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Affiliation(s)
- Ergun Y Uc
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha.
| | - Matthew Rizzo
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Amy M J O'Shea
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Steven W Anderson
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Jeffrey D Dawson
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
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13
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Jacobs M, Hart EP, Roos RAC. Driving with a neurodegenerative disorder: an overview of the current literature. J Neurol 2017; 264:1678-1696. [PMID: 28424901 PMCID: PMC5533843 DOI: 10.1007/s00415-017-8489-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Abstract
Driving is important for employment, social activities, and for the feeling of independence. The decision to cease driving affects the quality of life and has been associated with reduced mobility, social isolation, and sadness. Patients with neurodegenerative disorders can experience difficulties while driving due to their cognitive, motor, and behavioral impairments. The aim of this review is to summarize the available literature on changes in driving competence and behavior in patients with neurodegenerative disorders, with a particular focus on Huntington's (HD), Parkinson's (PD), and Alzheimer's disease (AD). A systematic literature search was conducted in the PubMed/Medline database. Studies using on-road or simulated driving assessments were examined in this review. In addition, studies investigating the association between cognitive functioning and driving were included. The review identified 70 studies. Only a few publications were available on HD (n = 7) compared to PD (n = 32) and AD (n = 31). This review revealed that driving is impaired in patients with neurodegenerative disorders on all levels of driving competence. The errors most commonly committed were on the tactical level including lane maintenance and lane changing. Deficits in executive functioning, attention, and visuospatial abilities can partially predict driving competence, and the performance on neuropsychological tests might be useful when discussing potential driving cessation. Currently, there is no gold standard to assess driving ability using clinical measures such as neuropsychological assessments, so more studies are necessary to detect valid screening tools and develop useful and reliable evidence-based guidelines.
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Affiliation(s)
- Milou Jacobs
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ellen P Hart
- Center for Human Drug Research, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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14
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Jitkritsadakul O, Bhidayasiri R. Physicians' role in the determination of fitness to drive in patients with Parkinson's disease: systematic review of the assessment tools and a call for national guidelines. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:14. [PMID: 27729986 PMCID: PMC5048693 DOI: 10.1186/s40734-016-0043-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Physicians are usually at the forefront when the issue of driving ability is raised by Parkinson's disease (PD) patients or their family members, even though few have been formally trained in this area. OBJECTIVES AND METHODS To identify relevant literature on driving assessment tools in patients with PD by performing a systematic review on this subject in order to provide background information for physicians on what types of driving assessment are available, and to delineate the role of physicians in providing fitness to drive recommendations. RESULTS Of 1,490 abstracts screened, 55 articles fulfilled the selection criteria that investigated assessment of driving ability in PD patients with questionnaires, off-road testing battery, driving simulators, and driving skill tests (on-road tests and naturalistic driving test). Despite different methodology across studies, PD patients were observed to commit more driving errors than controls. Poor driving performance correlated with motor, visual, and cognitive severity. Excessive daytime somnolence was common in PD drivers and the presence of falling asleep while driving was identified to be a significant predictor of car accidents. CONCLUSION Although the evidence indicated more driving errors among PD drivers as identified by various assessment tools, the extent on how physicians should be involved in the evaluation process and make related recommendations remain unclear. Driving safety is an important public health issue in PD that needs better-defined specific legal and medical guidelines. National guidelines that establish risk assessment protocols involving multidisciplinary assessments are needed to assist physicians in making appropriate referrals for additional evaluations and recommendations when patients are deemed to be unsafe drivers.
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Affiliation(s)
- Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
- Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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15
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Classen S, Alvarez L. Caregivers' Impressions Predicting Fitness to Drive in Persons With Parkinson's. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016; 36:5-13. [PMID: 27504688 DOI: 10.1177/1539449215601117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease, increasing in incidence, with a known impact on fitness to drive. Although great progress has been made on evidence-based guidelines for assessing fitness to drive of persons with PD, a need remains for early identification of at-risk drivers in need of comprehensive assessment. This study investigated whether caregivers of drivers with PD could predict the driver's on-road outcome. We also investigated whether the predictive value of their impressions differed from that of drivers themselves, their neurologist, or from information provided by standardized measures of visual and divided attention. Caregivers' risk impressions (odds ratio [OR] = 13.76, p = .03) and Trail Making Test Part B (Trails B; OR = 0.41, p = .02) emerged as significant predictors of passing an on-road assessment. Our findings suggest that caregiver impressions, with a measure of set shifting, may be used as an efficient screen to identify drivers with PD who are potentially at risk for failing an on-road assessment.
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16
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Devos H, Ranchet M, Emmanuel Akinwuntan A, Uc EY. Establishing an evidence-base framework for driving rehabilitation in Parkinson's disease: A systematic review of on-road driving studies. NeuroRehabilitation 2016; 37:35-52. [PMID: 26409692 DOI: 10.3233/nre-151239] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Individuals with Parkinson's disease (PD) experience problems with on-road driving that can be targeted in driving rehabilitation programs. OBJECTIVE To provide a framework for driving rehabilitation in PD by identifying the critical on-road driving impairments and their associated visual, cognitive, and motor deficits. METHODS We conducted a systematic review of the literature on on-road driving and naturalistic driving practices in PD. Relevant databases including Pubmed, Medline, PsychINFO, ISI Web of Science, Cochrane library, and ClinicalTrials.gov, were reviewed using the key words Parkinson's disease, on-road driving, naturalistic driving, and their related entry words. On-road driving skills were mapped onto an existing theoretic model of operational, tactical, and strategic levels. The on-road and off-road cognitive, motor, and visual predictors of global on-road driving were summarized. RESULTS Twenty-seven studies were included. All but one study were prospective and Class II studies according to the American Academy of Neurology Classification Criteria. Participants were on average 68 years old and in the mild to moderate stages of PD. Drivers with PD were more likely to fail a driving assessment compared to age- and gender-matched controls. Compared with controls, drivers with PD experienced difficulties on all levels of driving skill. However, the compensation strategies on the strategic level showed that drivers with PD were aware of their diminished driving skills on the operational and strategic levels. Operational and tactical on-road driving skills best predicted global on-road driving. A combination of visual, cognitive, and motor deficits underlie impaired on-road driving performance in PD. CONCLUSION Driving rehabilitation strategies for individuals with PD should include training of operational and tactical driving skills or indirect comprehensive training program of visual, cognitive, and motor skills.
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Affiliation(s)
- Hannes Devos
- Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| | - Maud Ranchet
- Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| | - Abiodun Emmanuel Akinwuntan
- Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA
| | - Ergun Y Uc
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Neurology Service, Veterans Affairs Medical Center, Iowa City, IA, USA
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17
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Fischer P, Ossandón JP, Keyser J, Gulberti A, Wilming N, Hamel W, Köppen J, Buhmann C, Westphal M, Gerloff C, Moll CKE, Engel AK, König P. STN-DBS Reduces Saccadic Hypometria but Not Visuospatial Bias in Parkinson's Disease Patients. Front Behav Neurosci 2016; 10:85. [PMID: 27199693 PMCID: PMC4853960 DOI: 10.3389/fnbeh.2016.00085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 04/15/2016] [Indexed: 12/25/2022] Open
Abstract
In contrast to its well-established role in alleviating skeleto-motor symptoms in Parkinson's disease, little is known about the impact of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on oculomotor control and attention. Eye-tracking data of 17 patients with left-hemibody symptom onset was compared with 17 age-matched control subjects. Free-viewing of natural images was assessed without stimulation as baseline and during bilateral DBS. To examine the involvement of ventral STN territories in oculomotion and spatial attention, we employed unilateral stimulation via the left and right ventralmost contacts respectively. When DBS was off, patients showed shorter saccades and a rightward viewing bias compared with controls. Bilateral stimulation in therapeutic settings improved saccadic hypometria but not the visuospatial bias. At a group level, unilateral ventral stimulation yielded no consistent effects. However, the evaluation of electrode position within normalized MNI coordinate space revealed that the extent of early exploration bias correlated with the precise stimulation site within the left subthalamic area. These results suggest that oculomotor impairments "but not higher-level exploration patterns" are effectively ameliorable by DBS in therapeutic settings. Our findings highlight the relevance of the STN topography in selecting contacts for chronic stimulation especially upon appearance of visuospatial attention deficits.
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Affiliation(s)
- Petra Fischer
- Institute of Cognitive Science, University of OsnabrückOsnabrück, Germany; Medical Research Council Brain Network Dynamics Unit, University of OxfordOxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of OxfordOxford, UK
| | - José P Ossandón
- Institute of Cognitive Science, University of Osnabrück Osnabrück, Germany
| | - Johannes Keyser
- Institute of Cognitive Science, University of Osnabrück Osnabrück, Germany
| | - Alessandro Gulberti
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Niklas Wilming
- Institute of Cognitive Science, University of OsnabrückOsnabrück, Germany; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Johannes Köppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Peter König
- Institute of Cognitive Science, University of OsnabrückOsnabrück, Germany; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-EppendorfHamburg, Germany
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18
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Devos H, Morgan JC, Onyeamaechi A, Bogle CA, Holton K, Kruse J, Sasser S, Akinwuntan AE. Use of a driving simulator to improve on-road driving performance and cognition in persons with Parkinson's disease: A pilot study. Aust Occup Ther J 2016; 63:408-414. [PMID: 27071987 DOI: 10.1111/1440-1630.12263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIM The use of simulators as an assessment and intervention tool for driving is an emerging field in occupational therapy. We investigated the potential usefulness of a driving simulator to improve on-road skills and cognitive functions in drivers with Parkinson's disease (PD). METHOD Fifteen participants with PD, and Hoehn and Yahr stages between 2 and 3 participated in this pre-post comparison study. Twelve of the 15 individuals (median age (Q1-Q3), 68 (63.5-72.5); 10 men) completed 10 hours of training in a high-fidelity driving simulator. A practical road test as well as off-road cognitive and simulator tests were administered at pre-training and post-training. RESULTS Nine participants, who passed the road test before training, passed at post-training. Furthermore, all three participants who initially failed the on-road test passed after training. Participants' performance improved significantly from pre- to post-training on two cognitive tests: (i) the Montreal Cognitive Assessment and (ii) Dot Cancellation test. CONCLUSION This pilot study demonstrates the potential usefulness of a simulator to improve on-road driving and driving-related cognitive skills in PD. Adequately powered randomized controlled trials are needed to further expand this field of study.
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Affiliation(s)
- Hannes Devos
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA.,Department of Neurology, Georgia Regents University, Augusta, GA, USA
| | - John C Morgan
- Department of Neurology, Georgia Regents University, Augusta, GA, USA.,Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Arinze Onyeamaechi
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
| | - Craig A Bogle
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
| | - Katie Holton
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
| | - Jonathon Kruse
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
| | - Sierra Sasser
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA.,Department of Neurology, Georgia Regents University, Augusta, GA, USA
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19
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Ranchet M, Tant M, Akinwuntan AE, Neal E, Devos H. Comorbidity in Drivers with Parkinson's Disease. J Am Geriatr Soc 2016; 64:342-6. [DOI: 10.1111/jgs.13942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maud Ranchet
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
| | - Mark Tant
- Center for Evaluation of Fitness to Drive and Car Adaptations; Belgian Road Safety Institute; Brussels Belgium
| | - Abiodun Emmanuel Akinwuntan
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
- Dean's Office; College of Allied Health Sciences; Augusta University; Augusta Georgia
| | - Erin Neal
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
| | - Hannes Devos
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta Georgia
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20
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Classen S, Holmes JD, Alvarez L, Loew K, Mulvagh A, Rienas K, Walton V, He W. Clinical Assessments as Predictors of Primary On-Road Outcomes in Parkinson's Disease. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2015; 35:213-20. [PMID: 27505901 DOI: 10.1177/1539449215601118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that affects fitness to drive. Research that has examined clinical predictors of fitness to drive in PD, using the on-road assessment as the gold standard, has generally used a dichotomous pass/fail decision. However, on-road assessments may also result in one of two additional outcomes (pass with recommendations, or fail-remediable). Individuals within these subgroups may benefit from interventions to improve their fitness to drive abilities. This study investigated clinical predictors that could be indicative of the pass, pass with recommendations, or fail-remediable categories for drivers with PD (N = 99). Trails B, Left Finger to Nose Test, and contrast sensitivity measures were identified as significant predictors for the pass, and pass with recommendations subgroups. No significant predictors were identified for the fail-remediable subgroup. Results from this study provide a foundation for clinicians to identify drivers who can benefit from recommendations to preserve their driving abilities.
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Affiliation(s)
| | | | - Liliana Alvarez
- University of Western Ontario, London, Canada Universidad del Rosario, Bogota, Colombia
| | | | | | | | | | - Wenqing He
- University of Western Ontario, London, Canada
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21
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Piersma D, de Waard D, Davidse R, Tucha O, Brouwer W. Car drivers with dementia: Different complications due to different etiologies? TRAFFIC INJURY PREVENTION 2015; 17:9-23. [PMID: 25874501 DOI: 10.1080/15389588.2015.1038786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability. METHODS The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar. RESULTS AND CONCLUSIONS Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia etiologies are taken into consideration.
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Affiliation(s)
- Dafne Piersma
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Dick de Waard
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Ragnhild Davidse
- b SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Oliver Tucha
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Wiebo Brouwer
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
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22
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Abstract
The outgoing editor-in-chief outlines the advances made during her 6-yr tenure and provides recommendations for AJOT’s future
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Affiliation(s)
- Sharon A Gutman
- Sharon A. Gutman, PhD, OTR, FAOTA, is former Editor-in-Chief, American Journal of Occupational Therapy, and Associate Professor, Programs in Occupational Therapy Research, Columbia University, New York, NY 10032;
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