Caregivers' Impressions Predicting Fitness to Drive in Persons With Parkinson's

Driving Impairment in Movement Disorders

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.

Visual Attention Cut Points for Driver Fitness in Parkinson's Disease

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.

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

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.