Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role

Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines

BACKGROUND

Motor/nonmotor symptomatology and antiparkinsonian drugs deteriorate the driving ability of Parkinson's disease (PD) patients.

OBJECTIVES

Treating neurologists are frequently asked to evaluate driving fitness of their patients and provide evidence-based consultation. Although several guidelines have been published, the exact procedure along with the neurologist's role in this procedure remains obscure.

METHODS

We systematically reviewed the existing guidelines, regarding driving fitness evaluation of PD patients. We searched MEDLINE and Google Scholar and identified 109 articles. After specified inclusion criteria were applied, 15 articles were included (nine national guidelines, five recommendation papers, and one consensus statement).

RESULTS

The treating physician is proposed as the initial evaluator in 8 of 15 articles (neurologist in 2 articles) and may refer patients for a second-line evaluation. The evaluation should include motor, cognitive, and visual assessment (proposed in 15, 13, and 8 articles, respectively). Specific motor tests are proposed in eight articles (cutoff values in four), whereas specific neuropsychological and visual tests are proposed in seven articles each (cutoff values in four and three articles, respectively). Conditional licenses are proposed in 11 of 15 articles, to facilitate driving for PD patients. We summarized our findings on a graphic of the procedure for driving fitness evaluation of PD patients.

CONCLUSIONS

Neurological aspects of driving fitness evaluation of PD patients are recognized in most of the guidelines. Motor, neuropsychological, visual, and sleep assessment and medication review are key components. Clear-cut instructions regarding motor, neuropsychological, and visual tests and relative cutoff values are lacking. Conditional licenses and periodical reevaluation of driving fitness are important safety measures.

Driving decisions after critical illness: Qualitative analysis of patient-provider reviews during ICU recovery clinic assessments

BACKGROUND

Driving a vehicle is a functional task requiring a threshold of physical, behavioral and cognitive skills.

OBJECTIVE

To report patient-provider evaluations of driving status and driving safety assessments after critical illness.

DESIGN

Qualitative secondary analysis of driving-related dialog drawn from a two-arm pilot study evaluating telemedicine delivery of Intensive Care Unit Recovery Clinic assessments. Multidisciplinary providers assessed physical, psychological, and cognitive recovery during one-hour telemedicine ICU-RC assessments. Qualitative secondary analysis of patient-provider dialog specific to driving practices after critical illness.

SETTING AND PATIENTS

Multidisciplinary Intensive Care Unit Recovery clinic assessment dialog between 17 patients and their providers during 3-week and/or 12-week follow-up assessments at a tertiary academic medical center in the Southeastern United States.

MAIN MEASURES AND KEY RESULTS

Thematic content analysis was performed to describe and classify driving safety discussion, driving status and driving practices after critical illness. Driving-related discussions occurred with 15 of 17 participants and were clinician-initiated. When assessed, driving status varied with participants reporting independent decisions to resume driving, delay driving and cease driving after critical illness. Patient-reported driving practices after critical illness included modifications to limit driving to medical appointments, self-assessments of trip durations, and inclusion of care partners as a safety measure for new onset fatigue while driving.

CONCLUSION

We found that patients are largely self-navigating this stage of recovery, making subjective decisions on driving resumption and overall driving status. These results highlight that driving status changes are an often underrecognized yet salient social cost of critical illness.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT03926533.

New balance capability index as a screening tool for mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) is not just a prodrome to dementia, but a very important intervention point to prevent dementia caused by Alzheimer's disease (AD). It has long been known that people with AD have a higher frequency of falls with some gait instability. Recent evidence suggests that vestibular impairment is disproportionately prevalent among individuals with MCI and dementia due to AD. Therefore, we hypothesized that the measurement of balance capability is helpful to identify individuals with MCI.

METHODS

First, we developed a useful method to evaluate balance capability as well as vestibular function using Nintendo Wii balance board as a stabilometer and foam rubber on it. Then, 49 healthy volunteers aged from 56 to 75 with no clinically apparent cognitive impairment were recruited and the association between their balance capability and cognitive function was examined. Cognitive functions were assessed by MoCA, MMSE, CDR, and TMT-A and -B tests.

RESULTS

The new balance capability indicator, termed visual dependency index of postural stability (VPS), was highly associated with cognitive impairment assessed by MoCA, and the area under the receiver operating characteristic (ROC) curve was more than 0.8, demonstrating high sensitivity and specificity (app. 80% and 60%, respectively).

CONCLUSIONS

Early evidence suggests that VPS measured using Nintendo Wii balance board as a stabilometer helps identify individuals with MCI at an early and preclinical stage with high sensitivity, establishing a useful method to screen MCI.

Treatment of Vascular and Neurodegenerative Forms of Cognitive Impairment and Dementias

Ideally, dementia care should be provided by a collaborative team. Eligible patients should be treated with the cognitive-enhancing medications, the cholinesterase inhibitors and memantine. For most of the common causes of dementia, there are no disease-modifying medications, with the exception that vascular dementia can be prevented by treating vascular risk factors to prevent stroke. There is hope that Alzheimer disease can be treated by using monoclonal antibodies that target amyloid beta, although more trials are needed. Holistic, patient-centered care can enhance quality and extend the time that the patient can live safely in the community.

Analysis on the Development and Influence of National Fitness Environment on Youth Basketball Coordination and Mental Health

In order to improve the basketball theory and provide theoretical and intellectual support for the scientific, mental health, and sustainable development of basketball, we propose to take the development dynamic mechanism of juvenile basketball as the research object and make a systematic and in-depth study on the dynamic mechanism, the cultivation of Chinese and foreign juvenile basketball reserve talents, and the dynamic dilemma and influencing factors of juvenile campus basketball development by using the methods of literature, questionnaire, and expert interview. A method of cultivating the ring tone of juvenile basketball is proposed. This method is based on Chan algorithm. When the target is close to each base station, the first estimation also needs an initial value to solve the initial solution estimation matrix. The method is also based on multivariate Taylor algorithm, taking into account the measured distance between the targets to be measured, so it will get some useful information, which will improve the positioning accuracy. The experimental results show that the accuracy of the algorithm used in this paper is more than 85%. However, the accuracy of rebounding and passing recognition and prediction is low. The recognition accuracy and prediction accuracy of the test set are slightly lower than that of the effective set, which shows that the performance of the target detection system model in this paper can be further improved through more significant training examples. It is proved that the algorithm based on Taylor ring can meet the needs of teenagers in the basketball coordination and mental health.