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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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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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Chang JH, Bhatti D, Rizzo M, Uc EY, Bertoni J, Merickel J. Real-World Driving Data Indexes Dopaminergic Treatment Effects in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1324-1332. [PMID: 37772286 PMCID: PMC10525064 DOI: 10.1002/mdc3.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/29/2023] [Accepted: 05/09/2023] [Indexed: 09/30/2023] Open
Abstract
Background Driving is a complex, everyday task that impacts patient agency, safety, mobility, social connections, and quality of life. Digital tools can provide comprehensive real-world (RW) data on driver behavior in patients with Parkinson's disease (PD), providing critical data on disease status and treatment efficacy in the patient's own environment. Objective This pilot study examined the use of driving data as a RW digital biomarker of PD symptom severity and dopaminergic therapy effectiveness. Methods Naturalistic driving data (3974 drives) were collected for 1 month from 30 idiopathic PD drivers treated with dopaminergic medications. Prescriptions data were used to calculate levodopa equivalent daily dose (LEDD). The association between LEDD and driver mobility (number of drives) was assessed across PD severity, measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Results PD drivers with worse motor symptoms based on self-report (Part II: P = 0.02) and clinical examination (Part III: P < 0.001) showed greater decrements in driver mobility. LEDD levels >400 mg/day were associated with higher driver mobility than those with worse PD symptoms (Part I: P = 0.02, Part II: P < 0.001, Part III: P < 0.001). Conclusions Results suggest that comprehensive RW driving data on PD patients may index disease status and treatment effectiveness to improve patient symptoms, safety, mobility, and independence. Higher dopaminergic treatment may enhance safe driver mobility in PD patients with worse symptom severity.
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Affiliation(s)
- Jun Ha Chang
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Danish Bhatti
- Department of Internal MedicineUniversity of Central FloridaOrlandoFloridaUSA
| | - Matthew Rizzo
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Ergun Y. Uc
- Department of NeurologyUniversity of IowaIowa CityIowaUSA
- Neurology ServiceIowa City VA Medical CenterIowa CityIowaUSA
| | - John Bertoni
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jennifer Merickel
- Department of Neurological SciencesUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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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: 3] [Impact Index Per Article: 3.0] [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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Furlanetti L, Baig Mirza A, Raslan A, Velicu MA, Burford C, Akhbari M, German E, Saha R, Samuel M, Ashkan K. Factors Influencing Driving following DBS Surgery in Parkinson's Disease: A Single UK Centre Experience and Review of the Literature. J Clin Med 2022; 12:jcm12010166. [PMID: 36614967 PMCID: PMC9821168 DOI: 10.3390/jcm12010166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Parkinson's disease (PD) is a complex neurodegenerative disorder, leading to impairment of various neurological faculties, including motor, planning, cognitivity, and executive functions. Motor- and non-motor symptoms of the disease may intensify a patient's restrictions to performing usual tasks of daily living, including driving. Deep Brain Stimulation (DBS) associated with optimized clinical treatment has been shown to improve quality of life, motor, and non-motor symptoms in PD. In most countries, there are no specific guidelines concerning minimum safety requirements and the timing of return to driving following DBS, leaving to the medical staff of individual DBS centres the responsibility to draw recommendations individually regarding patients' ability to drive after surgery. The aim of this study was to evaluate factors that might influence the ability to drive following DBS in the management of PD. A total of 125 patients were included. Clinical, epidemiological, neuropsychological, and surgical factors were evaluated. The mean follow-up time was 129.9 months. DBS improved motor and non-motor symptoms of PD. However, in general, patients were 2.8-fold less likely to drive in the postoperative period than prior to surgery. Among the PD characteristics, patients with the akinetic subtype presented a higher risk to lose their driving licence postoperatively. Furthermore, the presence of an abnormal postoperative neuropsychological evaluation was also associated with driving restriction following surgery. Our data indicate that restriction to drive following surgery seems to be multifactorial rather than a direct consequence of DBS itself. Our study sheds light on the urgent need for a standardised multidisciplinary postoperative evaluation to assess patients' ability to drive following DBS.
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Affiliation(s)
- Luciano Furlanetti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- King’s Health Partners Academic Health Sciences Centre, London SE1 9RT, UK
- Correspondence: ; Tel.: +44-(0)-203-299-3285
| | - Asfand Baig Mirza
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Ahmed Raslan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Maria Alexandra Velicu
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Charlotte Burford
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Melika Akhbari
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Elaine German
- Department of Neuropsychology, King’s College London, London SE5 8AB, UK
| | - Romi Saha
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Michael Samuel
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- King’s Health Partners Academic Health Sciences Centre, London SE1 9RT, UK
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Keyoumars Ashkan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
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Gotardi GC, Barbieri FA, Simão RO, Pereira VA, Baptista AM, Imaizumi LF, Moretto G, Navarro M, Polastri PF, Rodrigues ST. Parkinson's disease affects gaze behaviour and performance of drivers. ERGONOMICS 2022; 65:1302-1311. [PMID: 35023450 DOI: 10.1080/00140139.2022.2028901] [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: 07/28/2020] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
The aim of this study was to investigate the effects of PD and ageing on gaze behaviour and performance of drivers in a simulated task. Ten drivers with PD, ten neurologically healthy older drivers, and ten neurologically healthy younger adult drivers were asked to drive in a car simulator for three minutes, maintaining car speed between 100 and 120 km/h and avoiding collisions. Driver's eye movements were recorded. Drivers with PD had more collisions and spent less time driving within the speed zone than the younger-drivers. Drivers with PD performed an increased number of fixations towards task-irrelevant areas of the visual scene and higher visual entropy, indicating a more random gaze behaviour. Older drivers restricted their visual search to the lane area in order to detect threat-related stimuli. PD led to drops in performance of drivers in the car simulator. Practitioner summary: Parkinson's disease (PD) and ageing process caused a drop in driving performance. Drivers with PD made fewer fixations on task-relevant information and showed higher visual entropy than young adults. Older drivers restricted their visual search to the lane than other areas of interest.
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Affiliation(s)
- Gisele C Gotardi
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Information, Vision and Action, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Fabio A Barbieri
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Human Movement Research, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Rafael O Simão
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Information, Vision and Action, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Vinicius A Pereira
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Human Movement Research, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - André M Baptista
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Human Movement Research, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Luiz F Imaizumi
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Human Movement Research, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Gabriel Moretto
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Human Movement Research, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Martina Navarro
- Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Paula F Polastri
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Information, Vision and Action, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
| | - Sérgio T Rodrigues
- Graduate Program in Human Movement Science, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
- Laboratory of Information, Vision and Action, Department of Physical Education, Faculty of Sciences, São Paulo State University, Bauru, Brazil
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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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Comparison of the effects of alcohol and cannabis on visual function and driving performance. Does the visual impairment affect driving? Drug Alcohol Depend 2022; 237:109538. [PMID: 35717788 DOI: 10.1016/j.drugalcdep.2022.109538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/23/2022] [Accepted: 06/09/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Alcohol and cannabis are the most widely consumed psychoactive substances worldwide. This study compared the effects of alcohol and cannabis on visual function and driving performance, as well as self-perceived effects. Also, the relationship between visual effects under the influence and driving performance was studied. METHODS Sixty-four young drivers, with a history of alcohol and/or cannabis use were included. Of these, 33 were allocated to the alcohol group and 31 to the cannabis group. All participants were evaluated in a baseline session. The alcohol group underwent two sessions: after drinking 300 ml and 450 ml of red wine (A1 and A2). The cannabis group attended one session after smoking cannabis (C). Visual function was evaluated at the contrast sensitivity, stereoacuity, and intraocular straylight level. Participants drove a driving simulator. A general score (overall visual score, OVS; overall driving performance score, ODPS) was obtained for both visual functioning and driving performance. RESULTS The evaluation of visual function demonstrated a significant impairment in OVS for all conditions studied (A1, p = 0.005; A2, p < 0.001; C, p < 0.001) with respect to the baseline session. General driving performance (ODPS) demonstrated a significant worsening for the A2 condition (p = 0.003). Finally, a significant relationship between driving performance and visual function was found (rho=0.163, p = 0.039 and χ2 = 4.801, p = 0.028). CONCLUSIONS Cannabis and alcohol use negatively impact visual function. However, driving performance was only significantly affected by the higher alcohol dose. This impairment in visual function was significantly associated with worse driving performance.
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Kay KR, Uc EY. Real-life consequences of cognitive dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:113-136. [DOI: 10.1016/bs.pbr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Pengo M, Murueta-Goyena A, Teijeira-Portas S, Acera M, Del Pino R, Sáez-Atxukarro O, Diez-Cirarda M, Tijero B, Fernández-Valle T, Gómez Esteban JC, Gabilondo I. Impact of Visual Impairment on Vision-Related Quality of Life in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1633-1643. [PMID: 35466953 DOI: 10.3233/jpd-213143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Visual impairment is frequent and highly disabling in Parkinson's disease (PD); however, few studies have comprehensively evaluated its impact on vision-related quality of life. OBJECTIVE To evaluate the relationship between visual function tests and the visual impairment perceived by PD patients in daily living activities. METHODS We cross-sectionally evaluated 62 PD patients and 33 healthy controls (HC). Visual disability was measured with a comprehensive battery of primary visual function and visual cognition tests (visual outcomes), and vision-related quality of life was evaluated with the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25). The relationship between visual outcomes and NEI VFQ-25 sub-scores was analyzed with Pearson's correlations and stepwise linear regression. RESULTS In PD patients, and not in HC, most NEI VFQ-25 sub-scores were significantly correlated with Cube Analysis and Dot Counting from Visual Object and Space Perception (VOSP) battery (visual perception), Clock Drawing Test (visuoconstructive capacity) and Trail Making Test part-A (visual attention and processing speed) and to a lesser extent with high- and low-contrast visual acuity. Dot Counting (VOSP) was the test primarily associated with most NEI VFQ-25 sub-scores (5 out of 12). Roth-28 color test was the one that best explained the variance of Peripheral Vision (R2: 0.21) and Role Difficulties (R2: 0.36) sub-scores of NEI VFQ-25, while photopic contrast sensitivity explained 41% of Driving sub-score variance. CONCLUSION Vision-related quality of life in PD is mainly influenced by alterations in visual perception, visuoconstructive capacity and visual attention and processing speed. Future studies are warranted to confirm and further extend our findings.
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Affiliation(s)
- Marta Pengo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ane Murueta-Goyena
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Sara Teijeira-Portas
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Marian Acera
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Rocio Del Pino
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Oihane Sáez-Atxukarro
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Maria Diez-Cirarda
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Beatriz Tijero
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
| | - Tamara Fernández-Valle
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
| | - Juan Carlos Gómez Esteban
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
| | - Iñigo Gabilondo
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Neurology, Cruces University Hospital, Barakaldo, Spain
- Ikerbasque: The Basque Foundation for Science, Bilbao, Spain
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12
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Swain TA, McGwin G, Antin JF, Wood JM, Owsley C. Left Turns by Older Drivers With Vision Impairment: A Naturalistic Driving Study. Innov Aging 2021; 5:igab026. [PMID: 34549096 PMCID: PMC8448425 DOI: 10.1093/geroni/igab026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older drivers are overrepresented in collisions at intersections while making left turns across oncoming traffic. Using naturalistic driving methods, we evaluated the association between vision impairment and their left-turn characteristics. RESEARCH DESIGN AND METHODS In this prospective, observational study, vision impairment as defined by visual acuity, contrast sensitivity, visual processing speed, visual field sensitivity, and motion perception was assessed in drivers ≥70 years old. Data acquisition systems were installed in their personal vehicles recording video and vehicle kinematics. Driving during everyday life was recorded for 6 months. Data analysts evaluated a temporal data window surrounding randomly selected left turns at 4-way intersections. Left-turn traversals and turning behavior were evaluated in terms of age-adjusted associations with vision impairment. RESULTS The sample consisted of 151 older drivers. The number of turns studied was 473; 265 turns were rated as unsafe traversals, and 201 as problematic turning behavior. Drivers with slowed visual processing speed and visual field impairment were less likely to exhibit unsafe traversals (p < .05); those with worse contrast sensitivity, slowed visual processing speed, and visual field impairment were less likely to exhibit problematic turning behavior (p < .05). DISCUSSION AND IMPLICATIONS Using naturalistic driving, our study suggests older drivers with vision impairment exhibit better performance in making left turns than those without deficits, which contradicts older driver studies on left turns using driving simulators and on-road driving evaluations. Our findings suggest more cautious and self-regulatory behavior, which are consistent with older visually impaired drivers' commonly expressed concerns about their driving difficulties.
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Affiliation(s)
- Thomas A Swain
- Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham Birmingham, Alabama, USA
| | - Gerald McGwin
- Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham Birmingham, Alabama, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jonathan F Antin
- Vulnerable Road User Safety, Virginia Tech Transportation Institute, Blacksburg, Virginia, USA
| | - Joanne M Wood
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cynthia Owsley
- Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham Birmingham, Alabama, USA
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Using High-Frequency Information and RH to Estimate AQI Based on SVR. SENSORS 2021; 21:s21113630. [PMID: 34071076 PMCID: PMC8197084 DOI: 10.3390/s21113630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022]
Abstract
The Environmental Protection Administration of Taiwan’s Executive Yuan has set up many air quality monitoring stations to monitor air pollution in the environment. The current weather forecast also includes information used to predict air pollution. Since air quality indicators have a considerable impact on people, the development of a simple, fast, and low-cost method to measure the AQI value is a worthy topic of research. In this study, a method was proposed to estimate AQI. Visibility had a clear positive relationship with AQI. When images and AQI were compared, it was easy to see that visibility decreased with the AQI value increase. Distance is the main factor affecting visibility, so measuring visibility with images has also become a research topic. Images with high and low PM2.5 concentrations were used to obtain regions of interest (RoI). The pixels in the RoI were calculated to obtain high-frequency information. The high-frequency information of RoI, RH, and true AQI was used for training via SVR, which was used to generate the model for AQI estimation. One year of experimental samples was collected for the experiment. Two indices were used to evaluate the performance of the proposed method. The results showed that the proposed method could be used to estimate AQI with acceptable performance in a simple, fast, and low-cost way.
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14
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Feng T, Boyle LN. Sparse group regularization for semi-continuous transportation data. Stat Med 2021; 40:3267-3285. [PMID: 33843070 DOI: 10.1002/sim.8942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 01/17/2021] [Accepted: 02/16/2021] [Indexed: 11/08/2022]
Abstract
Motor vehicle crashes are a global public health concern. Most analysis have used zero-inflated count models for examining crash counts. However, few methods are available to account for safety metrics that have semi-continuous observations. This article considers the problem of variable selection for the semi-continuous zero-inflated (SCZI) models. These models include two parts: a zero-inflated part and a nonzero continuous part. A special group regularization is designed to accommodate the unique structure of two-part SCZI models, and a type of Bayesian information criterion is proposed to select tuning parameters. We illustrate the variable selection process of the proposed model using lane position data from a driving simulator study. In the study, drivers stay in the intended lane for the majority of their drive (zero-inflated part). On occasion, some drivers do drift out of their intended driving lane (nonzero continuous part). Our findings show that individual differences can be captured with the proposed model, which has implications for driving safety and the design of in-vehicle alerting systems.
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Affiliation(s)
- Tianshu Feng
- Industrial and Systems Engineering, University of Washington, Seattle, Washington, USA
| | - Linda Ng Boyle
- Industrial and Systems Engineering, University of Washington, Seattle, Washington, USA
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15
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Lloyd K, Gaunt D, Haunton V, Skelly R, Mann H, Ben-Shlomo Y, Henderson EJ. Driving in Parkinson's disease: a retrospective study of driving and mobility assessments. Age Ageing 2020; 49:1097-1101. [PMID: 32585014 DOI: 10.1093/ageing/afaa098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To guide decision-making about driving ability, some patients with Parkinson's disease (PD) undergo specialist driving assessment. However, decisions about driving safety in most patients need to be made without this definitive test. There is no consensus on what predicts unsafe driving in PD nor a validated prediction tool to guide clinician decision-making and the need to refer for further assessment. OBJECTIVES To describe the characteristics of patients with PD assessed at a Driving Mobility Centre and investigate factors that predict driving assessment outcome. METHODS Retrospective cohort study of patients with PD assessed between 2012 and 2016. Descriptive analyses and logistic models to determine factors predicting a negative outcome. RESULTS There were 86 assessments of patients with PD. The mean age was 70 years (±9.2), 86% were male, median disease duration 7 years (interquartile range 5-12.5 years) and 59% were referred by the Driver and Vehicle Licensing Agency. In total, 62% had a negative 'not drive' outcome. The Rookwood Driving Battery (RDB), depth of vision deficit, usual driving frequency, age, duration license held and response time were all predictors in univariable analysis. The RDB was the best predictor of assessment failure, conditional on other variables in a backward stepwise model (odds ratio 1.29; 95% confidence interval 1.05, 1.60; P = 0.015). CONCLUSIONS This is the first study to describe patients with PD undergoing driving assessments in the UK. In this population, RDB performance was the best predictor of outcome. Future prospective studies are required to better determine predictors of driving ability to guide development of prediction tools for implementation into clinical practice.
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Affiliation(s)
- Katherine Lloyd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob Skelly
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton, Derby, UK
| | - Helen Mann
- Driving and Mobility Centre (West of England), The Vassal Centre, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
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16
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Zhang Q, Aldridge GM, Narayanan NS, Anderson SW, Uc EY. Approach to Cognitive Impairment in Parkinson's Disease. Neurotherapeutics 2020; 17:1495-1510. [PMID: 33205381 PMCID: PMC7851260 DOI: 10.1007/s13311-020-00963-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/03/2023] Open
Abstract
Cognitive dysfunction is common in Parkinson's disease (PD) and predicts poor clinical outcomes. It is associated primarily with pathologic involvement of basal forebrain cholinergic and prefrontal dopaminergic systems. Impairments in executive functions, attention, and visuospatial abilities are its hallmark features with eventual involvement of memory and other domains. Subtle symptoms in the premotor and early phases of PD progress to mild cognitive impairment (MCI) which may be present at the time of diagnosis. Eventually, a large majority of PD patients develop dementia with advancing age and longer disease duration, which is usually accompanied by immobility, hallucinations/psychosis, and dysautonomia. Dopaminergic medications and deep brain stimulation help motor dysfunction, but may have potential cognitive side effects. Central acetylcholinesterase inhibitors, and possibly memantine, provide modest and temporary symptomatic relief for dementia, although there is no evidence-based treatment for MCI. There is no proven disease-modifying treatment for cognitive impairment in PD. The symptomatic and disease-modifying role of physical exercise, cognitive training, and neuromodulation on cognitive impairment in PD is under investigation. Multidisciplinary approaches to cognitive impairment with effective treatment of comorbidities, proper rehabilitation, and maintenance of good support systems in addition to pharmaceutical treatment may improve the quality of life of the patients and caregivers.
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Affiliation(s)
- Qiang Zhang
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa 52242 USA
- Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa USA
| | - Georgina M. Aldridge
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa 52242 USA
| | - Nandakumar S. Narayanan
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa 52242 USA
| | - Steven W. Anderson
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa 52242 USA
| | - Ergun Y. Uc
- Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa 52242 USA
- Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa USA
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17
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Hamedani AG, Abraham DS, Maguire MG, Willis AW. Visual Impairment Is More Common in Parkinson's Disease and Is a Risk Factor for Poor Health Outcomes. Mov Disord 2020; 35:1542-1549. [PMID: 32662528 PMCID: PMC8183672 DOI: 10.1002/mds.28182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Visual impairment is associated with hip fracture, depression, anxiety, and dementia in the general population, and many causes of visual impairment are preventable or treatable with early detection. However, the prevalence, outcomes, and healthcare utilization patterns associated with visual impairment have not been examined in Parkinson's disease (PD). METHODS We performed a cross-sectional analysis of all Medicare beneficiaries with complete data in 2014 and longitudinal analysis of beneficiaries with PD from 2010 to 2014. We used diagnosis and procedure codes to identify PD, visual impairment, eye exams, hip fracture, and neuropsychiatric disorders. We compared the prevalence of visual impairment using logistic regression and used Cox proportional hazards regression to examine visual impairment and incident hip fracture, depression, anxiety, dementia, and death. We also examined the frequency of eye exams in PD using repeated-measures logistic regression. RESULTS Among 26,209,997 Medicare beneficiaries in 2014, visual impairment was significantly more prevalent in PD (1.7%) than non-PD (0.71%) (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.56-1.65). In a longitudinal cohort of 542,224 Medicare beneficiaries with PD, less than 60% had a yearly eye exam. Visual impairment associated with increased hazard of depression (hazard ratio [HR], 1.23; 95% CI, 1.14-1.32), anxiety (HR, 1.34; 95% CI, 1.24-1.43), dementia (HR, 1.28; 95% CI, 1.21-1.36), and death (HR, 1.49; 95% CI, 1.44-1.55). CONCLUSION Visual impairment is more common in PD than the general population and is associated with negative PD-related outcomes. Understanding the mechanisms for these relationships is important for guiding future interventions to improve health outcomes in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ali G. Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle S. Abraham
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen G. Maguire
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Allison W. Willis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Park Y, Bae Y. Brake time is correlated with lower extremity strength, dynamic balance and low-contrast sensitivity in unpredictable driving situations in elderly drivers compared with young drivers: A cross-sectional study. Geriatr Gerontol Int 2020; 20:571-577. [PMID: 32249521 DOI: 10.1111/ggi.13915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/06/2020] [Accepted: 03/08/2020] [Indexed: 11/28/2022]
Abstract
AIMS To compare physical function, driving fitness and brake time of young and elderly drivers, and to identify the association of physical function and driving fitness with brake time in elderly drivers in predictable or unpredictable situations during driving. METHODS This study included 86 participants (50 men and 36 women), comprising 52 elderly drivers (age: 72.44 years, weight: 60.39 kg, height: 158.06 cm) and 34 young drivers (age: 26.53 years, weight: 63.74 kg, height: 153.65 cm), with a valid driver's license who drive at least once a week. Physical function was measured as upper and lower body flexibility and strength, dynamic balance and aerobic endurance. Driving fitness was measured as high- and low-contrast sensitivity, route planning, visualization of missing information, visual search with divided attention and visual information processing speed using the DrivingHealth® Inventory. Brake time and braking distance was evaluated as unpredictable and predictable driving situations. RESULTS Measurements of all categories, except lower extremity flexibility, endurance and high-contrast sensitivity, were significantly lower in elderly drivers than in young drivers. Brake time did not differ in predictable situations but was slower (P = 0.004) in elderly drivers in unpredictable situations. In elderly drivers, upper body strength (P = 0.036), dynamic balance (P < 0.001) and low-contrast sensitivity (P = 0.003) were associated with brake time in unpredictable driving situations. CONCLUSIONS In unpredictable situations, slower brake time in elderly drivers is associated with lower limb muscle strength, agility and low-contrast sensitivity. Therefore, for safe driving, these parameters should be considered as guidelines for maintaining the driving ability of elderly drivers and aging people. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- Yongnam Park
- Department of Physical Therapy, Suwon Women's University, Suwon-si, Republic of Korea
| | - Youngsook Bae
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
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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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20
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Gupta HV, Zhang N, Driver-Dunckley E, Mehta SH, Beach TG, Adler CH. Contrast Acuity With Different Colors in Parkinson's Disease. Mov Disord Clin Pract 2019; 6:672-677. [PMID: 31745477 DOI: 10.1002/mdc3.12821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/12/2022] Open
Abstract
Background Abnormal color vision and contrast acuity may have significant impact on daily activities. Objective Evaluate color visual acuity, at high and low contrast, in Parkinson's disease (PD) and controls using an iPad application. Methods Color visual acuity was tested with the Variable Contrast Acuity Chart (King-Devick Test LLC, Oakbrook Terrace, IL) on an iPad 2 at 40 cms using five colors (red, green, blue, yellow, and black) at low (2.5%) and high (100%) contrast. A numerical score (0-95) was assigned based on the number of correctly identified letters. Results Thirty-six PD (mean ± standard deviation age 68 ± 10 years) and 36 controls (72 ± 11.2 years) were studied. PD disease duration was 6.4 ± 4.6 years; MDS-UPDRS part II was 11.7 ± 7.0, and part III was 24.5 ± 9.9. After adjusting for age and sex, PD patients had significantly (P < 0.05) lower scores at high (100%) as well as low (2.5%) contrast for all five colors tested (red, green, blue, yellow, and black), except yellow low contrast (2.5%; P = 0.10). The largest effect size (0.88) was with yellow high contrast, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy using a cut-off score of 82 was 31%, 97%, 92%, 58%, and 64%, respectively. No correlation to disease duration was found. Conclusions This iPad application may be a simple-to-use biomarker for assessing color vision in PD. Further research is needed to determine disease specificity and whether there is a role in monitoring disease progression, treatment response, and identifying prodromal PD.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology Mayo Clinic College of Medicine Scottsdale Arizona USA
| | - Nan Zhang
- Department of Biostatistics Mayo Clinic Scottsdale Arizona USA
| | | | - Shyamal H Mehta
- Department of Neurology Mayo Clinic College of Medicine Scottsdale Arizona USA
| | - Thomas G Beach
- Banner Sun Health Research Institute Sun City Arizona USA
| | - Charles H Adler
- Department of Neurology Mayo Clinic College of Medicine Scottsdale Arizona USA
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21
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Zhang XH, Chen ZY, Su BB, Soobraydoo K, Wu HR, Ren QZ, Sun L, Lyu F, Jiang J. Preliminary study on visual recognition under low visibility conditions caused by artificial dynamic smog. Int J Ophthalmol 2018; 11:1821-1828. [PMID: 30450314 DOI: 10.18240/ijo.2018.11.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/18/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To quantitatively evaluate the effect of a simulated smog environment on human visual function by psychophysical methods. METHODS The smog environment was simulated in a 40×40×60 cm3 glass chamber filled with a PM2.5 aerosol, and 14 subjects with normal visual function were examined by psychophysical methods with the foggy smog box placed in front of their eyes. The transmission of light through the smog box, an indication of the percentage concentration of smog, was determined with a luminance meter. Visual function under different smog concentrations was evaluated by the E-visual acuity, crowded E-visual acuity and contrast sensitivity. RESULTS E-visual acuity, crowded E-visual acuity and contrast sensitivity were all impaired with a decrease in the transmission rate (TR) according to power functions, with invariable exponents of -1.41, -1.62 and -0.7, respectively, and R2 values of 0.99 for E and crowded E-visual acuity, 0.96 for contrast sensitivity. Crowded E-visual acuity decreased faster than E-visual acuity. There was a good correlation between the TR, extinction coefficient and visibility under heavy-smog conditions. CONCLUSION Increases in smog concentration have a strong effect on visual function.
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Affiliation(s)
- Xu-Hong Zhang
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zhe-Yi Chen
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Bin-Bin Su
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Karunanedi Soobraydoo
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Hao-Ran Wu
- Aier School of Ophthalmology, Central South University, Changsha 410083, Hunan Province, China
| | - Qin-Zhuan Ren
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Lu Sun
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Fan Lyu
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jun Jiang
- Department of Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Guo L, Normando EM, Shah PA, De Groef L, Cordeiro MF. Oculo-visual abnormalities in Parkinson's disease: Possible value as biomarkers. Mov Disord 2018; 33:1390-1406. [DOI: 10.1002/mds.27454] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Li Guo
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Eduardo M. Normando
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
| | - Parth Arvind Shah
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Lies De Groef
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Neural Circuit Development and Regeneration Research Group, Department of Biology; University of Leuven; Leuven Belgium
| | - M. Francesca Cordeiro
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
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Jacobs M, Hart EP, Miranda YM, Groeneveld GJ, van Gerven JMA, Roos RAC. Altered driving performance of symptomatic Huntington's disease gene carriers in simulated road conditions. TRAFFIC INJURY PREVENTION 2018; 19:708-714. [PMID: 30273496 DOI: 10.1080/15389588.2018.1497796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments. METHODS This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups. RESULTS Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway. CONCLUSIONS Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD.
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Affiliation(s)
- Milou Jacobs
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands
| | - Ellen P Hart
- b Centre for Human Drug Research , Leiden , The Netherlands
| | - Yuri Mejia Miranda
- c Department of Statistics , Centre for Human Drug Research , Leiden , The Netherlands
| | | | | | - Raymund A C Roos
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands
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Harand C, Mondou A, Chevanne D, Bocca ML, Defer G. Evidence of attentional impairments using virtual driving simulation in multiple sclerosis. Mult Scler Relat Disord 2018; 25:251-257. [PMID: 30144695 DOI: 10.1016/j.msard.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Detection of attentional disorders in complex situation related to daily life activities in multiple sclerosis patients needs better adapted tools than traditional cognitive assessment. OBJECTIVE To investigate the usefulness of virtual reality assessment of attention in multiple sclerosis, especially to evaluate alertness and divided attention using driving simulation. METHODS In this preliminary study, 11 relapsing-remitting patients (median EDSS: 2; mean disease duration of 10.3 years) and 11 healthy matched controls performed a driving simulation under three conditions (monotonous driving, divided attention driving and urban driving) where Standard Deviation of Lateral position (SDLP) was the main evaluated criteria. In comparison, traditional cognitive assessment of attentional functions was administered (SDMT, alertness and divided attention of TAP battery). Statistical non-parametric Mann-Whitney U tests were used to compare performances between groups in the two types of assessments. Exploratory correlational analyses were further conducted. RESULTS No significant difference was observed between groups for traditional attentional assessment except for information processing speed (SDMT; p < 0.01). Considering virtual reality, patients were less efficient than controls on the primary parameter of safe driving (SDLP; p < 0.05). They also committed more errors and omissions (p < 0.01) and speed fluctuations (p < 0.01) during the divided-attention driving condition. Urban driving did not reveal difference between groups. Lack of significant correlations between traditional and virtual reality attentional assessment suggested that they do not evaluate the same cognitive processes. CONCLUSION Patients experienced difficulties in maintaining the trajectory and the speed of the simulated vehicle which may be indicative of attentional difficulties, especially alertness and divided attention. These impairments were not revealed by the traditional cognitive assessment. Results of this preliminary study shed new light about the usefulness of virtual reality techniques and their future interest as a part of cognitive rehabilitation programs. They also highlights the need to develop driving preventive measures in MS.
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Affiliation(s)
- C Harand
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France.
| | - A Mondou
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France
| | - D Chevanne
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France
| | - M L Bocca
- Normandie University, UNICAEN, INSERM, U1075, COMETE, 14000 Caen, France
| | - G Defer
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France; Réseau Bas-Normand Pour la Prise en Charge de la SEP, 14000 Caen, France
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Thompson T, Poulter D, Miles C, Solmi M, Veronese N, Carvalho AF, Stubbs B, Uc EY. Driving impairment and crash risk in Parkinson disease: A systematic review and meta-analysis. Neurology 2018; 91:e906-e916. [PMID: 30076275 DOI: 10.1212/wnl.0000000000006132] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To provide the best possible evidence base for guiding driving decisions in Parkinson disease (PD), we performed a meta-analysis comparing patients with PD to healthy controls (HCs) on naturalistic, on-the-road, and simulator driving outcomes. METHODS Seven major databases were systematically searched (to January 2018) for studies comparing patients with PD to HCs on overall driving performance, with data analyzed using random-effects meta-analysis. RESULTS Fifty studies comprising 5,410 participants (PD = 1,955, HC = 3,455) met eligibility criteria. Analysis found the odds of on-the-road test failure were 6.16 (95% confidence interval [CI] 3.79-10.03) times higher and the odds of simulator crashes 2.63 (95% CI 1.64-4.22) times higher for people with PD, with poorer overall driving ratings also observed (standardized mean differences from 0.50 to 0.67). However, self-reported real-life crash involvement did not differ between people with PD and HCs (odds ratio = 0.84, 95% CI 0.57-1.23, p = 0.38). Findings remained unchanged after accounting for any differences in age, sex, and driving exposure, and no moderating influence of disease severity was found. CONCLUSIONS Our findings provide persuasive evidence for substantive driving impairment in PD, but offer little support for mandated PD-specific relicensure based on self-reported crash data alone, and highlight the need for objective measures of crash involvement.
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Affiliation(s)
- Trevor Thompson
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
| | - Damian Poulter
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Clare Miles
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Marco Solmi
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Nicola Veronese
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - André F Carvalho
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Brendon Stubbs
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
| | - Ergun Y Uc
- From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA
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Mikulskaya E, Martin FH. Contrast sensitivity and motion discrimination in cannabis users. Psychopharmacology (Berl) 2018; 235:2459-2469. [PMID: 29909427 DOI: 10.1007/s00213-018-4944-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 06/05/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE Cannabis use impairs visual attention; however, it is unclear whether cannabis use also impairs low level visual processing or whether low level visual deficits can be related to lower dopaminergic functioning found in cannabis users. OBJECTIVES To investigate whether spatiotemporal contrast sensitivity and motion discrimination under normal and low luminance conditions differ in cannabis users and non-users. METHODS Control (n = 20) and cannabis (n = 21) participants completed a visual acuity test, a saliva test and self-report measures. Spatial and temporal contrast thresholds, motion coherence thresholds for translational and radial motion and the spontaneous eye blink rate were then collected. RESULTS Cannabis users showed decreased spatial contrast sensitivity under low luminance conditions and increased motion coherence thresholds under all luminance levels tested compared to non-users. No differences in temporal contrast sensitivity were found between the groups. Frequency of cannabis use correlated significantly and negatively with contrast sensitivity, both spatial and temporal, in the cannabis group and higher motion coherence thresholds for radial motion were also associated with more frequent cannabis use in this group. The eye blink rate was significantly lower in cannabis users compared to non-users. CONCLUSIONS The present study shows that cannabis use is associated with deficits in low level visual processing. Such deficits are suggested to relate to lower dopamine, in a similar manner as in clinical populations. The implications for driving safety under reduced visibility (e.g. night) in abstaining cannabis users are discussed.
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Affiliation(s)
- Elena Mikulskaya
- School of Psychology, University of Newcastle, Ourimbah, NSW, 2258, Australia.,TIEI, Russian Federation, Tula University, Tula, Russia
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27
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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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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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Mikulskaya E, Martin F. Visual attention to motion stimuli and its neural correlates in cannabis users. Eur J Neurosci 2017; 47:269-276. [PMID: 29266467 DOI: 10.1111/ejn.13810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/21/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
Attention to motion stimuli and correct motion perception are vital for road safety. Although cannabis use has been associated with increased road crash risks, there is limited research on attentional processing of moving stimuli in cannabis users. This study investigated the neural correlates of the three-stimulus oddball task in cannabis users (n = 18) and non-users (n = 23) in response to moving stimuli. Stimulus contrast was under 16% against a low luminance background (M luminance < 16 cd/m2 ). The two groups did not differ in accuracy or in N2 peak amplitude; however, N2 latency was longer for target and standard stimuli in the cannabis group than in the control group. The cannabis group also showed a significantly reduced P3b amplitude in response to target stimuli. The AUDIT score was added as a random factor to the anova to rule out the effects of uneven alcohol consumption in the two groups. A significant group effect was found for N2 latency in response to target and standard stimuli and a significant interaction between the group, and the AUDIT score was found for the P3b peak amplitude for the distractor and standard stimuli, but not for the target stimuli. The results of this study suggest that cannabis use relates to reduced neural activity underlying attention to motion stimuli. Implications for regular early-onset cannabis use road safety are discussed.
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Affiliation(s)
- Elena Mikulskaya
- School of Psychology, University of Newcastle, Newcastle, NSW, Australia.,Tula University, TIEI, Tula, Russian
| | - Frances Martin
- School of Psychology, University of Newcastle, Newcastle, NSW, Australia
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30
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Brandt AU, Zimmermann HG, Oberwahrenbrock T, Isensee J, Müller T, Paul F. Self-perception and determinants of color vision in Parkinson's disease. J Neural Transm (Vienna) 2017; 125:145-152. [PMID: 29143216 DOI: 10.1007/s00702-017-1812-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/08/2017] [Indexed: 11/26/2022]
Abstract
Visual dysfunction is common in patients with Parkinson's disease (PD). The objective of this study was to investigate the perceived impact of visual dysfunction and especially color vision loss on PD patients, and to identify retinal and disease factors associated with color vision. Thirty PD patients and thirty-four healthy controls were included. Participants performed the Farnsworth-Munsell Hue-100 test (FMT). Patients answered the National Eye Institute Visual Function Questionnaire (NEI-VFQ), Unified Parkinson's Disease Rating Scale (UPDRS) assessment, and underwent optical coherence tomography with measurement of retinal nerve fiber layer, ganglion cell layer + inner plexiform layer (GCIPL), and outer nuclear and photoreceptor layer. Dopaminergic treatment was assessed as levodopa equivalent dose (LED). Vision domains significantly worse in PD patients compared to normative data were General Vision, Near Activities, Distance Activities, Vision-Specific Dependency, Driving, and Peripheral Vision. Worse NEI-VFQ total scores were associated with worse UPDRS, higher LED, and higher age, but not with FMT, visual acuity, or OCT measures. Only two patients (7%) reported problems with color vision. In contrast, patients performed significantly worse in the FMT than healthy controls and 17 (56.7%) patients were outside the 95th percentile of normative data. In multiple regression analyses, lower LED and higher age were associated with worse color vision in the FMT. PD patients are not aware of color vision deficits. Given the impact of color vision loss on everyday tasks in other conditions, future research should investigate the impact of vision deficits on disease burden in PD.
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Affiliation(s)
- Alexander U Brandt
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hanna G Zimmermann
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Timm Oberwahrenbrock
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Justine Isensee
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Müller
- Department of Neurology, Alexianer St. Joseph-Krankenhaus Berlin-Weißensee, Gartenstraße 1, 13088, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
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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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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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Schmidt JD, Hoffman NL, Ranchet M, Miller LS, Tomporowski PD, Akinwuntan AE, Devos H. Driving after Concussion: Is It Safe To Drive after Symptoms Resolve? J Neurotrauma 2017; 34:1571-1578. [DOI: 10.1089/neu.2016.4668] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
| | | | - Maud Ranchet
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, Georgia
- Laboratory Ergonomics and Cognitive Sciences applied to Transport, Lyon, France
| | | | | | | | - Hannes Devos
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, Georgia
- University of Kansas Medical Center, Kansas City, Kansas
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Rumalla K, Gondi KT, Reddy AY, Mittal MK. Association of Parkinson's disease with hospitalization for traumatic brain injury. Int J Neurosci 2016; 127:326-333. [PMID: 27647380 DOI: 10.1080/00207454.2016.1239196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The goal of our study was to determine if patients with Parkinson's disease (PD) are more susceptible to hospitalization for traumatic brain injury (TBI). METHODS The US Nationwide Inpatient Sample database was queried (2004-2011) to identify cohorts of patients with PD (N = 1 047 656) and without PD (N = 115 95 173). The age range of the study population was 60-89 years. The incidence of TBI among patients with PD was compared to the incidence of TBI in patients without PD. A multivariate logistic regression model, adjusted for all covariates that significantly differed in the bivariate analyses, was used to determine if PD was an independent predictor of TBI hospitalization. RESULTS The incidence of TBI hospitalization was significantly higher (relative risk: 1.76, 95% CI: 1.73-1.80) in the PD cohort. The PD cohort with TBI had fewer comorbidities and risk factors for falls/TBI compared to the non-PD cohort with TBI. The multivariable analysis, adjusting for other TBI risk factors, revealed that PD status increased the likelihood of TBI hospitalization (odds ratio: 2.99, 95% CI: 2.93-3.05). CONCLUSION Our study shows that patients with PD are more susceptible to hospitalization for TBI. A greater proportion of fall-related TBI occurs in patients with PD compared to patients without PD. Further research is needed to prevent falls in PD patients to avoid TBI.
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Affiliation(s)
- Kavelin Rumalla
- a University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Keerthi T Gondi
- a University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Adithi Y Reddy
- a University of Missouri-Kansas City School of Medicine , Kansas City , MO , USA
| | - Manoj K Mittal
- b Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
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Ridder A, Müller MLTM, Kotagal V, Frey KA, Albin RL, Bohnen NI. Impaired contrast sensitivity is associated with more severe cognitive impairment in Parkinson disease. Parkinsonism Relat Disord 2016; 34:15-19. [PMID: 27742131 DOI: 10.1016/j.parkreldis.2016.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Dopaminergic degeneration affects both nigrostriatal projection neurons and retinal amacrine cells in Parkinson disease (PD). Parkinsonian retinopathy is associated with impaired color discrimination and contrast sensitivity. Some prior studies described associations between color discrimination deficits and cognitive deficits in PD, suggesting that contrast discrimination deficits are due, at least in part, to cognitive deficits in PD. We investigated the relationship between cognitive deficits and impaired contrast sensitivity in PD. METHODS PD subjects, n = 43; 15F/28M; mean age 66.5 ± 8.2, Hoehn and Yahr stage 2.6 ± 0.6, and duration of disease of 6.2 ± 5.0 years underwent neuropsychological and Rabin contrast sensitivity testing. RESULTS Mean Rabin contrast sensitivity score was 1.34 ± 0.40. Bivariate analyses showed significant correlation between Rabin contrast sensitivity scores and global cognitive z-scores (R = 0.54, P = 0.0002). Cognitive domain Z-score post hoc analysis demonstrated most robust correlation between Rabin scores and executive functions (R = 0.49, P = 0.0009), followed by verbal learning (R = 0.44, P = 0.0028), visuospatial (R = 0.39, P = 0.001) and attention z-scores (R = 0.32, P = 0.036). CONCLUSIONS Impaired contrast sensitivity in PD is robustly associated with cognitive deficits, particularly executive function deficits. These results suggest that contrast sensitivity may be a useful biomarker for cognitive changes in PD and may have implications for driving safety evaluations in PD.
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Affiliation(s)
- A Ridder
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - M L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA
| | - V Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - K A Frey
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - R L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA
| | - N I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Radiology, University of Michigan, Ann Arbor, MI, USA; University of Michigan, Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA; Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, USA.
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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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Vardaki S, Devos H, Beratis I, Yannis G, Papageorgiou SG. Exploring the association between working memory and driving performance in Parkinson's disease. TRAFFIC INJURY PREVENTION 2016; 17:359-366. [PMID: 26376369 DOI: 10.1080/15389588.2015.1091926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to explore whether varying levels of operational and tactical driving task demand differentially affect drivers with Parkinson's disease (PD) and control drivers in their sign recall. METHODS Study participants aged between 50 and 70 years included a group of drivers with PD (n = 10) and a group of age- and sex-matched control drivers (n = 10). Their performance in a sign recall task was measured using a driving simulator. RESULTS Drivers in the control group performed better than drivers with PD in a sign recall task, but this trend was not statistically significant (P =.43). In addition, regardless of group membership, subjects' performance differed according to varying levels of task demand. Performance in the sign recall task was more likely to drop with increasing task demand (P =.03). This difference was significant when the variation in task demand was associated with a cognitive task; that is, when drivers were required to apply the instructions from working memory. CONCLUSIONS Although the conclusions drawn from this study are tentative, the evidence presented here is encouraging with regard to the use of a driving simulator to examine isolated cognitive functions underlying driving performance in PD. With an understanding of its limitations, such driving simulation in combination with functional assessment batteries measuring physical, visual, and cognitive abilities could comprise one component of a multitiered system to evaluate medical fitness to drive.
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Affiliation(s)
- Sophia Vardaki
- a Department of Transportation Planning and Engineering , School of Civil Engineering, National Technical University of Athens , Athens , Greece
| | - Hannes Devos
- b Department of Physical Therapy , Georgia Regents University , Augusta , Georgia
| | - Ion Beratis
- c Department of Neurology , ATTIKON General University Hospital, Medical School, University of Athens , Athens , Greece
| | - George Yannis
- a Department of Transportation Planning and Engineering , School of Civil Engineering, National Technical University of Athens , Athens , Greece
| | - Sokratis G Papageorgiou
- c Department of Neurology , ATTIKON General University Hospital, Medical School, University of Athens , Athens , Greece
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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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Crizzle AM, Myers AM, Roy EA, Almeida QJ. Associations Between Falls, Balance Confidence, Driving Speed, Braking, and Other Driving Practices in Parkinson's Disease. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2014. [DOI: 10.3109/02703181.2014.991057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Emre M, Ford PJ, Bilgiç B, Uç EY. Cognitive impairment and dementia in Parkinson's disease: practical issues and management. Mov Disord 2014; 29:663-72. [PMID: 24757114 DOI: 10.1002/mds.25870] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 11/11/2022] Open
Abstract
Cognitive impairment and dementia pose particular challenges in the management of patients with Parkinson's disease (PD). Decision-making capacity can render patients vulnerable in a way that requires careful ethical considerations by clinicians with respect to medical decision making, research participation, and public safety. Clinicians should discuss how future decisions will be made as early in the disease course as possible. Because of cognitive, visual, and motor impairments, PD may be associated with unsafe driving, leading to early driving cessation in many. DBS of the STN and, to a lesser degree, globus pallidus interna (GPi) has consistently been associated with decreased verbal fluency, but significant global cognitive decline is usually not observed in patients who undergo rigorous selection. There are some observations suggesting lesser cognitive decline in GPi DBS than STN DBS, but further research is required. Management of PD dementia (PDD) patients involves both pharmacological and nonpharmacological measures. Patients with PDD should be offered treatment with a cholinesterase inhibitor taking into account expected benefits and potential risks. Treatment with neuroleptics may be necessary to treat psychosis; classical neuroleptics, as well as risperidone and olanzapine, should be avoided. Quetiapine might be considered first-line treatment because it does not need special monitoring, although the strongest evidence for efficacy exists for clozapine. Evidence from randomized, controlled studies in the PDD population is lacking; selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors may be used to treat depressive features. Clonazepam or melatonin may be useful in the treatment of rapid eye movement behavior disorder.
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Affiliation(s)
- Murat Emre
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul, Turkey
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Classen S, Brumback B, Monahan M, Malaty II, Rodriguez RL, Okun MS, McFarland NR. Driving errors in Parkinson's disease: moving closer to predicting on-road outcomes. Am J Occup Ther 2014; 68:77-85. [PMID: 24367958 DOI: 10.5014/ajot.2014.008698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Age-related medical conditions such as Parkinson's disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age = 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age = 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), χ²(1) = 35.54, HC N = 138, PD N = 99, p < .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R² =.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t(61) = 7.004, p < .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so.
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Affiliation(s)
- Sherrilene Classen
- Sherrilene Classen, PhD, MPH, OTR/L, is Professor and Director, School of Occupational Therapy, Elborn College, Room 2555B, 1201 Western Road, Western University, London, Ontario N6G 1H1 Canada. At the time of the study, she was Director, Institute for Mobility, Activity and Participation, and Associate Professor, Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville;
| | - Babette Brumback
- Babette Brumback, PhD, is Professor and Program Director, Department of Biostatistics, University of Florida, Gainesville
| | - Miriam Monahan
- Miriam Monahan, MS OT, CDRS, is Occupational Therapist and Certified Driving Rehabilitation Specialist, Department of Occupational Therapy and Institute for Mobility, Activity and Participation, University of Florida, Gainesville
| | - Irene I Malaty
- Irene I. Malaty, MD, is Assistant Professor, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville
| | - Ramon L Rodriguez
- Ramon L. Rodriguez, MD, is Director, Movement Disorders Clinic, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville
| | - Michael S Okun
- Michael S. Okun, MD, is Co-Director, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville
| | - Nikolaus R McFarland
- Nikolaus R. McFarland, MD, PhD, is Assistant Professor, Department of Neurology, University of Florida, Gainesville
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Diederich NJ, Stebbins G, Schiltz C, Goetz CG. Are patients with Parkinson's disease blind to blindsight? Brain 2014; 137:1838-49. [PMID: 24764573 PMCID: PMC4032103 DOI: 10.1093/brain/awu094] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/08/2014] [Accepted: 03/15/2014] [Indexed: 12/22/2022] Open
Abstract
In Parkinson's disease, visual dysfunction is prominent. Visual hallucinations can be a major hallmark of late stage disease, but numerous visual deficits also occur in early stage Parkinson's disease. Specific retinopathy, deficits in the primary visual pathway and the secondary ventral and dorsal pathways, as well as dysfunction of the attention pathways have all been posited as causes of hallucinations in Parkinson's disease. We present data from patients with Parkinson's disease that contrast with a known neuro-ophthalmological syndrome, termed 'blindsight'. In this syndrome, there is an absence of conscious object identification, but preserved 'guess' of the location of a stimulus, preserved reflexive saccades and motion perception and preserved autonomical and expressive reactions to negative emotional facial expressions. We propose that patients with Parkinson's disease have the converse of blindsight, being 'blind to blindsight'. As such they preserve conscious vision, but show erroneous 'guess' localization of visual stimuli, poor saccades and motion perception, and poor emotional face perception with blunted autonomic reaction. Although a large data set on these deficits in Parkinson's disease has been accumulated, consolidation into one specific syndrome has not been proposed. Focusing on neuropathological and physiological data from two phylogenetically old and subconscious pathways, the retino-colliculo-thalamo-amygdala and the retino-geniculo-extrastriate pathways, we propose that aberrant function of these systems, including pathologically inhibited superior colliculus activity, deficient corollary discharges to the frontal eye fields, dysfunctional pulvinar, claustrum and amygdaloid subnuclei of the amygdala, the latter progressively burdened with Lewy bodies, underlie this syndrome. These network impairments are further corroborated by the concept of the 'silent amygdala'. Functionally being 'blind to blindsight' may facilitate the highly distinctive 'presence' or 'passage' hallucinations of Parkinson's disease and can help to explain handicaps in driving capacities and dysfunctional 'theory of mind'. We propose this synthesis to prompt refined neuropathological and neuroimaging studies on the pivotal nuclei in these pathways in order to better understand the networks underpinning this newly conceptualized syndrome in Parkinson's disease.
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Affiliation(s)
- Nico J Diederich
- 1 Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg2 Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, Luxembourg3 Department of Neurological Sciences, Rush University Medical Centre, Chicago, USA
| | - Glenn Stebbins
- 3 Department of Neurological Sciences, Rush University Medical Centre, Chicago, USA
| | - Christine Schiltz
- 4 Institute of Cognitive Science and Assessment, Research Unit Education, Culture, Cognition and Society, University of Luxembourg, Luxembourg-City, Luxembourg
| | - Christopher G Goetz
- 3 Department of Neurological Sciences, Rush University Medical Centre, Chicago, USA
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Devos H, Vandenberghe W, Tant M, Akinwuntan AE, De Weerdt W, Nieuwboer A, Uc EY. Driving and off-road impairments underlying failure on road testing in Parkinson's disease. Mov Disord 2013; 28:1949-56. [DOI: 10.1002/mds.25701] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/03/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hannes Devos
- Department of Rehabilitation Sciences; Katholieke Universiteit (KU) Leuven-University of Leuven; Leuven Belgium
- National Advanced Driving Simulator; University of Iowa; Iowa City Iowa USA
- Department of Physical Therapy; Georgia Regents University; Augusta Georgia USA
| | - Wim Vandenberghe
- Department of Neurology; University Hospitals Leuven; Leuven Belgium
- Department of Neurosciences; Katholieke Universiteit (KU) Leuven-University of Leuven; Leuven Belgium
| | - Mark Tant
- Center for Evaluation of Fitness to Drive (CARA); Belgian Road Safety Institute; Brussels Belgium
| | | | - Willy De Weerdt
- Department of Rehabilitation Sciences; Katholieke Universiteit (KU) Leuven-University of Leuven; Leuven Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences; Katholieke Universiteit (KU) Leuven-University of Leuven; Leuven Belgium
| | - Ergun Y. Uc
- Department of Neurology; University of Iowa; Iowa City Iowa USA
- Neurology Service; Veterans Affairs Medical Center; Iowa City Iowa USA
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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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Crizzle AM, Myers AM, Roy EA, Almeida QJ. Drivers with Parkinson's disease: are the symptoms of PD associated with restricted driving practices? J Neurol 2013; 260:2562-8. [PMID: 23821027 DOI: 10.1007/s00415-013-7017-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/18/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
This study examined whether symptoms (motor, cognitive, vision, sleepiness, depression) of Parkinson's disease (PD) were associated with restricted driving practices. To quantify driving practices, electronic devices were installed in the vehicles of 27 drivers with PD (78 % men; M = 71.6, SD = 6.6; Unified Parkinson's Disease Rating Scale (UPDRS) motor score M = 30.1, SD = 8.6; disease duration M = 3.9, SD = 2.8 years) and 20 controls (80 % men; M = 70.6, SD = 7.9) for 2 weeks. Participants completed measures of sleepiness, depression, quality of life, and assessments of motor, cognitive and visual functions. The PD group had significantly slower brake response times (p < 0.05), poorer cognitive and quality of life scores (p < 0.01) and greater depression (p < 0.05) compared to controls. Slower reaction time was significantly related to reduced driving; specifically, fewer trips (r = -0.46; p < 0.05), distance (r = -0.54, p < 0.01) and duration at night (r = -0.58, p < 0.01). Better cognitive scores were associated with driving less often in difficult situations such as bad weather and rush hour (p < 0.05), as well as reduced speed on city streets, but only for the control group. While most drivers with PD rated their overall health as good or excellent, the five PD drivers who rated their health more poorly had significantly worse clinical symptoms (UPDRS motor scores, contrast sensitivity, depression, brake response time) and more restricted driving patterns. These findings show that drivers with PD who perceive their health poorly have greater symptomatology and were more likely to restrict their driving, possibly due to noticeable declines in multiple driving-related abilities.
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Affiliation(s)
- Alexander M Crizzle
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada,
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46
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Devos H, Vandenberghe W, Nieuwboer A, Tant M, De Weerdt W, Dawson JD, Uc EY. Validation of a screening battery to predict driving fitness in people with Parkinson's disease. Mov Disord 2013; 28:671-4. [DOI: 10.1002/mds.25387] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 12/21/2012] [Accepted: 01/10/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Alice Nieuwboer
- Department of Rehabilitation Sciences; KU Leuven; Heverlee; Belgium
| | - Mark Tant
- Center for Evaluation of Fitness to Drive and Car Adaptations (CARA); Belgian Road Safety Institute; Brussels; Belgium
| | - Willy De Weerdt
- Department of Rehabilitation Sciences; KU Leuven; Heverlee; Belgium
| | - Jeffrey D. Dawson
- Department of Biostatistics; University of Iowa; Iowa City; Iowa; USA
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Abstract
Being a licensed driver in the United States and many other countries facilitates health and well-being. Based on the vision standards in most states, individuals with worse than 20/40 visual acuity who desire licensure are denied through the usual licensure application process. However, >40 states have bioptic telescope licensing programs where applicants can gain licensure contingent on meeting specific requirements. Despite the existence of the bioptic telescope and these licensing programs since the 1970s, there has been little rigorous scientific study of this topic. Here, I offer an organizing perspective for a research agenda on driving with bioptic telescopes, with the long-term practical goal being to provide an evidence basis for licensure policies and training programs.
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48
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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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Crizzle AM, Myers AM. Examination of naturalistic driving practices in drivers with Parkinson's disease compared to age and gender-matched controls. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:724-731. [PMID: 22795036 DOI: 10.1016/j.aap.2012.06.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/24/2012] [Accepted: 06/26/2012] [Indexed: 06/01/2023]
Abstract
A few studies suggest that drivers with Parkinson's disease (PD) may self-regulate or modify their driving behavior more than drivers without neurological disorders; however findings are limited to self-report. The purpose of this study was to objectively examine whether drivers with PD show more restrictive driving practices (exposure and patterns). Electronic devices were installed in the vehicles of 27 drivers with PD (71.6±6.6; 78% men) and 20 matched controls (70.6±7.9; 80% men) for two weeks and driving data were matched with aerial maps, weather and daylight archives and trip logs to examine driving context. Compared to controls, the PD group drove significantly less overall (number of trips, kilometres, duration), and proportionately less at night and on days with bad weather suggesting more restricted driving practices, congruent with lower ratings of driving comfort and abilities. However, they may not necessarily drive more cautiously or safely as they drove significantly faster (and over the speed limit) on highways and freeways and 19% reported driving problems over the two weeks. These preliminary findings need to be replicated and longitudinal studies using objective indicators are needed to examine changes in driving practices, as well as crash outcomes, as disease severity progresses.
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Affiliation(s)
- Alexander M Crizzle
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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Crizzle AM, Classen S, Lanford D, Malaty IA, Okun MS, Wagle Shukla A, McFarland NR. Driving performance and behaviors: a comparison of gender differences in Parkinson's disease. TRAFFIC INJURY PREVENTION 2013; 14:340-345. [PMID: 23531256 DOI: 10.1080/15389588.2012.717730] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The primary objective of this study was to determine gender differences by comparing self-reported driving behaviors, clinical tests, and on-road driving performance in a cohort of men and women drivers with Parkinson's disease (PD). METHODS In this prospective observational study, we analyzed data of a convenience sample of 63 men (mean age = 70.9 ± 6.6 years) and 21 women (mean age 67.1 ± 7.3 years) with diagnosed PD. All participants underwent a comprehensive driving evaluation by a certified driving rehabilitation specialist. RESULTS On average, both men and women were active drivers (driving ∼4.6 times/week). A substantial proportion of both groups avoided driving at night (40% of men versus 46% of women), during rush hour, and in heavy traffic (36% of men versus 57% of women), although the differences were not significant. Both groups reported some avoidance behaviors: making left-hand turns (9.7% men versus 9.5% women), driving in the rain (12.9% men versus 19.0% women), or on the interstate/highway (14.3% men versus 7.7% women). With respect to driving performance, both groups were equally likely to fail the on-road test (42.6% men versus 42.9% women). Although men committed slightly more total driving errors compared to women, the differences were not statistically significant. Specific driving errors also did not differ by gender. Controlling for gender and disease severity, age was an independent predictor of total driving errors in men but not in women. Additionally, a cut-point of ≥2.5 on the modified Hoehn and Yahr was predictive of pass-fail outcomes in men when controlling for age. CONCLUSIONS Our study shows preliminary evidence that few gender differences exist with respect to driving errors and overall driving performance. Future studies should better balance gender distribution by age in PD driving studies to determine whether there are indeed differences in driving performance between men and women.
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Affiliation(s)
- Alexander M Crizzle
- Department of Occupational Therapy and Institute for Activity, Mobility and Participation, University of Florida, Gainesville, Florida 32601-0164, USA.
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