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Stamatelos P, Economou A, Yannis G, Stefanis L, Papageorgiou SG. Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines. Mov Disord Clin Pract 2024; 11:198-208. [PMID: 38164044 PMCID: PMC10928339 DOI: 10.1002/mdc3.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
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.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| | - Alexandra Economou
- Department of PsychologyNational and Kapodistrian University of AthensAthensGreece
| | - George Yannis
- Department of Transportation Planning and EngineeringSchool of Civil Engineering, National Technical University of AthensAthensGreece
| | - Leonidas Stefanis
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| | - Sokratis G. Papageorgiou
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
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Sleep Disorders and Cognitive Dysfunctions in Parkinson's Disease: A Meta-Analytic Study. Neuropsychol Rev 2021; 31:643-682. [PMID: 33779875 DOI: 10.1007/s11065-020-09473-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/20/2020] [Indexed: 02/08/2023]
Abstract
A relationship between sleep disorders and cognitive dysfunctions was reported in Parkinson's Disease (PD), however, some studies did not confirm the link. A meta-analytic study was performed to investigate the relationship between sleep disorders and cognitive dysfunctions, and to clarify the evolution of cognitive status in PD patients with sleep disorders.The systematic literature search was performed up to November 2020 using PubMed, Scopus, and PsycINFO databases. We included studies published in peer-reviewed journals in English providing results about neuropsychological comparison between patients with or without sleep disorders. Meta-analysis on cross-sectional data included 54 studies for REM Sleep Behavior Disorder (RBD), 22 for Excessive Daytime Sleepiness (EDS), 7 for Obstructive Sleep Apnea (OSA), 13 for Restless Legs Syndrome (RLS), and 5 for insomnia, the meta-analysis on longitudinal data included 7 studies.RBD was related to deficits of global cognitive functioning, memory, executive functions, attention/working memory, language, and visuospatial abilities. EDS was associated with deficits of global cognitive functioning and attention and working memory abilities, whereas RLS and OSA were related to global cognitive dysfunction. Moreover, we revealed that PD patients with RBD and those with EDS performed worse than PD patients without sleep disorders at follow-up rather than baseline evaluation. Our results suggest that sleep disorders are associated with cognitive deficits supporting indirectly that these, especially the REM Sleep Behavior Disorder, reflect abnormalities of frontal networks and posterior cortical areas. Sleep disorders in patients with PD seem to also increase the risk for long-term cognitive decline.
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Forsman Å, Anund A, Skyving M, Filtness AJ. Injury crashes and the relationship with disease causing excessive daytime sleepiness. TRAFFIC INJURY PREVENTION 2021; 22:272-277. [PMID: 33769162 DOI: 10.1080/15389588.2021.1894639] [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: 09/29/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study was to understand the relationship between some of the most common diseases that are known to contribute to excessive daytime sleepiness (EDS) and traffic injury crashes. Specific focus was on the relationship between disease and crash type (single-vehicle or multiple-vehicle crash) and between disease and injury severity. METHODS This registry-based study considered all passenger car drivers involved in a crash in Sweden between 2011 and 2016 who were 40 years or older at the time of the crash (n = 54,090). For each crash-involved driver, selected medical diagnoses registered from 1997 until the day before the crash were extracted from the National Patient Register. The drivers were assigned to 1 of 4 groups, depending on prior diseases: sleep apnea (SA; group 1, n = 2,165), sleep disorders (group 2, n = 724), Parkinson's or epilepsy (group 3, n = 645) and a reference group (group 4, n = 50,556). Logistic regression analysis compared single-vehicle crashes with multiple-vehicle crashes and moderately/severely injured drivers with slightly/uninjured drivers. RESULTS Drivers with EDS-related diseases (groups 1-3) had higher probability of a single-vehicle crash than a multiple-vehicle crash compared to the reference group. The most sizeable effect was found for Parkinson's/epilepsy with an odds ratio (OR) of 2.5 (confidence interval [CI], 2.1-3.0). For multiple-vehicle crashes, the probability of a moderate/severe injury was higher for drivers with other sleep disorders (OR = 1.5; CI, 1.0-2.2) and Parkinson's/epilepsy (OR = 1.6; CI, 1.1-2.3) compared to the reference group. CONCLUSIONS This study has made first steps toward understanding the relationship between some of the most common diseases that are known to contribute to EDS and crashes. Having Parkinson's/epilepsy, in particular, elevated the probability of a single-vehicle crash compared to a multiple-vehicle crash. A single-vehicle crash was seen as indicative of causing a crash; thus, having Parkinson's/epilepsy could be interpreted as a risk factor for crash involvement. Having Parkinson's/epilepsy, as well as other sleep disorders, was also related to more severe outcomes in multiple-vehicle crashes, given that a crash occurred. This was not identified in single-vehicle crashes.
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Affiliation(s)
- Åsa Forsman
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
| | - Anna Anund
- The Swedish National Road and Transport Research Institute (VTI), Linköping, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
- Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Marie Skyving
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Road and Rail Department, Swedish Transport Agency, Kista, Sweden
| | - Ashleigh J Filtness
- Transport Safety Research Centre, SDCA, Loughborough University, Loughborough, Leicestershire, UK
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Feng F, Cai Y, Hou Y, Ou R, Jiang Z, Shang H. Excessive daytime sleepiness in Parkinson's disease: A systematic review and meta-analysis. Parkinsonism Relat Disord 2021; 85:133-140. [PMID: 33637423 DOI: 10.1016/j.parkreldis.2021.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To provide a robust estimate of the prevalence of excessive daytime sleepiness (EDS) and its clinical correlates in patients with Parkinson's disease (PD). METHOD We searched the PubMed and Embase databases for studies investigating the prevalence and clinical correlates of EDS from inception to March 01, 2020. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale. Random-effects models were set to pool the risk estimates. Sensitivity analyses were performed to evaluate the stability of the outcomes. RESULTS After screening 1367 titles and abstracts, 59 studies involving 12,439 participants were included in the systematic review and meta-analysis. The pooled prevalence of EDS in PD was 35.1%, which was higher in South America, North America, Europe, and Australia than that in Asia. Compared to patients without EDS, patients with EDS had higher effect size on disease duration (0.76 years; 95% CI: 0.16-1.37, I2 = 68.8%), Hoehn and Yahr (HY) stage (0.23 grade; 95% CI: 0.11-0.34, I2 = 69.1%), Unified PD Rating Scale (UPDRS)-III (3.02 points; 95% CI: 1.53-4.51, I2: 61.2%), levodopa equivalent daily dose (LEDD) (141.46 mg; 95% CI: 64.17-218.77, I2 = 86.1%), depression symptoms (Hedges' g = 0.35; 95% CI: 0.15-0.55, I2 = 72.0%) and male sex (OR = 1.50; 95% CI: 1.30-1.72, I2 = 0). CONCLUSION Our results showed that approximately one-third of patients with PD had EDS, which may be associated with the severity of the disease, depression, and male sex, or a combination of neurodegeneration and medication.
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Affiliation(s)
- Fei Feng
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - YingYing Cai
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - YanBing Hou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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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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Badenes D, Garolera M, Casas L, Cejudo-Bolivar JC, Zaragoza S, Calzado N, Aguilar M. Relationship between neuropsychological tests and driver's license renewal tests in Parkinson's disease. TRAFFIC INJURY PREVENTION 2018; 19:125-132. [PMID: 28759268 DOI: 10.1080/15389588.2017.1360491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine whether the standard Spanish driving test (ASDE test) was able to identify patients with Parkinson's disease (PD) at risk of unsafe driving and to examine the relationship between the ASDE test and the Useful Field of View (UFOV) as well as with a battery of neuropsychological tests in drivers with PD. METHODS Thirty-seven patients with PD and 33 controls matched by age and education level were included in an observational study. All participants were active drivers and patients with PD underwent study procedures after taking the medication in the "on" period. Subjects with a Mini-Mental State Examination (MMSE) score ≤ 24 were excluded. Neuropsychological tests (Repeatable Battery for Neuropsychological Status [RBANS], Trail Making Test [TMT-A and -B], and Block Design test), driving performance tests (ASDE Driver Test and UFOV), and daytime sleepiness (Epworth Sleepiness Scale) were assessed. RESULTS The PD group performed significantly worse than healthy controls in the ASDE Motor Coordination tests. No significant differences were observed in anticipation speed, multiple reaction time, concentrated attention, and resistance to monotony. All participants successfully completed the UFOV tests. Statistically significant differences between patients with PD and controls were found in processing speed (UFOV1; P =.03) and more patients with PD were found in the categories of higher driving risk levels (P =.03). In addition, patients with PD showed worse scores than healthy controls in visuospatial capacities (Line Orientation), psychomotor speed (Coding and TMT-A), memory (List Recognition, Story Recall), and executive function (TMT-B). The driving tests (ASDE and UFOV) showed a low sensitivity and a high specificity but a higher percentage of patients in the PD group failed in multiple reaction time, concentrated attention, and resistance to monotony. In addition, 18.9% of patients with PD showed a cutoff of 4 for UFOV risk. In the discriminant analysis, Line Orientation (visuospatial/constructive domain) and Figure Recall (delayed memory) were found to be statistically significant with a rate of correct classification of unsafe drivers with PD of 78.2%. In addition, normal results on the Line Orientation item were associated with a 1.5 times higher probability of non-risky driving in the multivariate analysis. CONCLUSIONS At early stages of the disease, about 19% of patients with PD showed difficulties that may affect their driving capabilities. Line Orientation and Figure Recall are useful to alert clinicians to the risk of unsafe driving. For this reason, patients with PD should be evaluated for driving abilities more regularly to determine the extent of deficits that may influence driving performance.
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Affiliation(s)
- Dolors Badenes
- a Servei de Neurologia , Hospital Universitari Mutua Terrassa , Terrassa , Spain
- b Neurology, Department of Psychiatry and Forensic Medicine , Universitat Autonoma de Barcelona Facultat de Medicina , Barcelona , Spain
| | - Maite Garolera
- c Neuropsychological Unit, Consorci Sanitari de Terrassa , Terrassa , Spain
| | - Laura Casas
- a Servei de Neurologia , Hospital Universitari Mutua Terrassa , Terrassa , Spain
| | | | - Silvia Zaragoza
- e Neuropsychological Research Organization (Psyncro) , Sant Joan Despi , Spain
| | - Noemi Calzado
- a Servei de Neurologia , Hospital Universitari Mutua Terrassa , Terrassa , Spain
| | - Miquel Aguilar
- a Servei de Neurologia , Hospital Universitari Mutua Terrassa , Terrassa , Spain
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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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Salawu F, Olokoba A. Excessive daytime sleepiness and unintended sleep episodes associated with Parkinson's disease. Oman Med J 2015; 30:3-10. [PMID: 25829994 DOI: 10.5001/omj.2015.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/07/2014] [Indexed: 12/20/2022] Open
Abstract
This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinson's disease (PD) and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD.
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Affiliation(s)
- Fatai Salawu
- Department of Medicine, Federal Medical Centre, Yola, Nigeria
| | - Abdulfatai Olokoba
- Department of General Internal Medicine, University of Ilorin Teaching Hospital, Ilorin. Nigeria
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Ranchet M, Paire-Ficout L, Uc EY, Bonnard A, Sornette D, Broussolle E. Impact of specific executive functions on driving performance in people with Parkinson's disease. Mov Disord 2013; 28:1941-8. [DOI: 10.1002/mds.25660] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 08/01/2013] [Accepted: 08/04/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Ergun Y. Uc
- Department of Neurology; University of Iowa; Iowa City Iowa USA
- Neurology Service; Veterans Affairs Medical Center; Iowa City Iowa USA
| | | | | | - Emmanuel Broussolle
- Université Lyon I; Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C; Lyon France
- CNRS, UMR 5229; Centre de Neurosciences Cognitives; Lyon France
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Abstract
The growing literature on driving in Parkinson disease (PD) has shown that driving is impaired in PD compared to healthy comparison drivers. PD is a complex neurodegenerative disorder leading to motor, cognitive, and visual impairments, all of which can affect fitness to drive. In this review, we examined studies of driving performance (on-road tests and simulators) in PD for outcome measures and their predictors. We searched through various databases and found 25 (of 99) primary studies, all published in English. Using the American Academy of Neurology criteria, a study class of evidence was assigned (I-IV, I indicating the highest level of evidence) and recommendations were made (Level A: predictive or not; B: probably predictive or not; C: possibly predictive or not; U: no recommendations). From available Class II and III studies, we identified various cognitive, visual, and motor measures that met different levels of evidence (usually Level B or C) with respect to predicting on-road and simulated driving performance. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with PD are needed by policy makers and clinicians to develop evidence-based guidelines.
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Affiliation(s)
- Alexander M Crizzle
- Departments of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.
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Ranchet M, Broussolle E, Poisson A, Paire-Ficout L. Relationships between cognitive functions and driving behavior in Parkinson's disease. Eur Neurol 2012; 68:98-107. [PMID: 22759624 DOI: 10.1159/000338264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/11/2012] [Indexed: 11/19/2022]
Abstract
Alterations in cognitive functions in Parkinson's disease (PD) have been reported even in mild stages of the disease. These functions may play a role in complex daily activities, such as driving. This article provides an overview on the relationships between cognitive functions and driving behavior in PD in driving simulator and on-road studies. The role of attention, executive functions, visual memory, visuospatial construction and information processing speed is discussed. In driving simulator studies, driving performances were correlated with several neuropsychological measures, especially those of Trail Making Test (TMT), Brixton and Symbol Digit Modalities Test. In on-road studies, TMT, Useful Field Of View and Block Design tests appear as good predictors of driving performances. Most of these tests are also relevant to driving in Alzheimer's disease and traumatic brain injury.
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Affiliation(s)
- Maud Ranchet
- IFSTTAR, LESCOT, Fondation Partenariale, Bron, France. maud.ranchet @ ifsttar.fr
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Amick MM, Grace J, Ott BR. Visual and cognitive predictors of driving safety in Parkinson's disease patients. Arch Clin Neuropsychol 2007; 22:957-67. [PMID: 17851032 PMCID: PMC3555123 DOI: 10.1016/j.acn.2007.07.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Revised: 07/18/2007] [Accepted: 07/24/2007] [Indexed: 11/29/2022] Open
Abstract
This study assessed the clinical utility of contrast sensitivity (CS) relative to attention, executive function, and visuospatial abilities for predicting driving safety in participants with Parkinson's disease (PD). Twenty-five, non-demented PD patients completed measures of contrast sensitivity, visuospatial skills, executive functions, and attention. All PD participants also underwent a formal on-road driving evaluation. Of the 25 participants, 11 received a marginal or unsafe rating on the road test. Poorer driving performance was associated with worse performance on measures of CS, visuospatial constructions, set shifting, and attention. While impaired driving was associated with a range of cognitive and visual abilities, only a composite measure of executive functioning and visuospatial abilities, and not CS or attentional skills, predicted driving performance. These findings suggest that neuropsychological tests, which are multifactorial in nature and require visual perception and visual spatial judgments are the most useful screening measures for hazardous driving in PD patients.
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Affiliation(s)
- M M Amick
- Memorial Hospital of RI, Department of Medical Rehabilitation, Pawtucket, RI 02860, USA.
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