1
|
Flieger M, Schäbitz W, Schlueter DA, Austerschmidt KL, Koenig J, Beblo T, Driessen M, Toepper M. Somatic Factors Predict On-Road Driving Skills in Older Drivers and Drivers with Mild Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2024; 79:glae152. [PMID: 38872422 DOI: 10.1093/gerona/glae152] [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: 04/02/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND On-road driving skills can be impaired in older drivers and drivers with mild cognitive impairment (MCI) due to different driving-relevant deficits. Among these deficits, somatic factors have received little attention so far. METHODS In a prospective observational on-road driving study, we examined whether somatic factors can predict on-road driving skills in a mixed sample of healthy older drivers and drivers with MCI (n = 99) and whether the inclusion of age explains additional variance. Somatic factors included the number of prescribed drugs, visual acuity, peripheral visual field integrity, mobility of the cervical spine, and hearing impairment. A hierarchical regression analysis was used to predict on-road driving skills by adding the somatic factors in the first step and age in the second step. RESULTS Results revealed that the combination of somatic factors significantly predicted on-road driving skills (R2adjusted = 0.439). The inclusion of age led to a significant increase of explained variance (R2adjusted = 0.466). CONCLUSIONS Our results suggest that somatic factors can accurately predict on-road driving skills in healthy older drivers and drivers with MCI. In addition, our results suggest that there is a significant but rather small effect of age beyond somatic changes.
Collapse
Affiliation(s)
- Maximilian Flieger
- Department of Psychiatry and Psychotherapy, Medical School and University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Wolf Schäbitz
- Department of Neurology, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Daniel A Schlueter
- Department of Psychiatry and Psychotherapy, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Kim L Austerschmidt
- Department of Psychiatry and Psychotherapy, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Jessica Koenig
- Department of Psychiatry and Psychotherapy, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | - Max Toepper
- Department of Psychiatry and Psychotherapy, University Medical Center OWL, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
2
|
Karrer L, Pfleger E, Kolominsky-Rabas P. Aktuelle Evidenzlage zur Beurteilung der Fahrtauglichkeit von
Menschen mit kognitiven Einschränkungen: Ein systematisches
Review. DAS GESUNDHEITSWESEN 2022; 85:354-363. [PMID: 35073594 PMCID: PMC10125319 DOI: 10.1055/a-1690-6940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Einleitung Aufgrund der hohen Prävalenz demenzieller Erkrankungen
handelt es sich bei der Überprüfung der Fahrtauglichkeit von
Menschen mit kognitiven Beeinträchtigungen um ein Thema von
großer gesellschaftlicher Relevanz.
Methodik Es wurde eine umfassende systematische Literaturrecherche zu der
Forschungsfrage: „Welche evidenz-basierten Methoden eignen sich zur
Beurteilung der Fahrtauglichkeit von Menschen mit Demenz (MmD) oder milden
kognitiven Einschränkungen (MCI)?“ für den Zeitraum
2015–2020 durchgeführt. Die Recherche erfolgte in den
Datenbanken Medline, PsycINFO, LIVIVO, PubPsych, Scopus, Cinahl und CENTRAL.
Ergebnisse 30 Studien wurden in die qualitative Analyse eingeschlossen.
Die Fahrtauglichkeit kann mit praxisbasierten Testverfahren wie Praxisfahrtest
(On-road), Fahrsimulator und Fahrverhaltensbeurteilung im natürlichen
Umfeld (Naturalistic Driving) beurteilt werden. Theoriebasierte Methoden sind:
neuropsychologische Tests, fahrspezifische Testungen und Fragebögen zur
Selbsteinschätzung. Die Studienlage zeigt, dass einzelne
neuropsychologische Tests nicht zur Bestimmung der Fahrtauglichkeit ausreichen.
Eine höhere Aussagekraft haben praxisbasierte Testverfahren,
fahrspezifische Testungen sowie Kombinationen aus evidenz-basierten
Methoden.
Schlussfolgerungen Die Überprüfung der Fahrtauglichkeit
von Menschen mit kognitiven Beeinträchtigungen sollte angesichts des
progredienten Verlaufs demenzieller Erkrankungen engmaschig durch eine
Kombination aus theorie- und praxisbasierter Methoden erfolgen.
Collapse
Affiliation(s)
- Linda Karrer
- Interdisziplinäres Zentrum für Health Technology
Assessment (HTA) und Public Health (IZPH),
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU),
Erlangen, Deutschland
| | - Elisabeth Pfleger
- Interdisziplinäres Zentrum für Health Technology
Assessment (HTA) und Public Health (IZPH),
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU),
Erlangen, Deutschland
| | - Peter Kolominsky-Rabas
- Interdisziplinäres Zentrum für Health Technology
Assessment (HTA) und Public Health (IZPH),
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU),
Erlangen, Deutschland
| |
Collapse
|
3
|
Abstract
INTRODUCTION The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. METHODS We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. RESULTS Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. CONCLUSION Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
Collapse
Affiliation(s)
- Anca Bejenaru
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA
| | - James M Ellison
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA.,Department of Family and Community Medicine, Christiana Care, Wilmington, DE, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
4
|
Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
Collapse
Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
| |
Collapse
|
5
|
Toepper M, Schulz P, Beblo T, Driessen M. Predicting On-Road Driving Skills, Fitness to Drive, and Prospective Accident Risk in Older Drivers and Drivers with Mild Cognitive Impairment: The Importance of Non-Cognitive Risk Factors. J Alzheimers Dis 2021; 79:401-414. [PMID: 33325384 PMCID: PMC7902978 DOI: 10.3233/jad-200943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND On-road driving behavior can be impaired in older drivers and particularly in drivers with mild cognitive impairment (MCI). OBJECTIVE To determine whether cognitive and non-cognitive risk factors for driving safety may allow an accurate and economic prediction of on-road driving skills, fitness to drive, and prospective accident risk in healthy older drivers and drivers with MCI, we examined a representative combined sample of older drivers with and without MCI (N = 74) in an observational on-road study. In particular, we examined whether non-cognitive risk factors improve predictive accuracy provided by cognitive factors alone. METHODS Multiple and logistic hierarchical regression analyses were utilized to predict different driving outcomes. In all regression models, we included cognitive predictors alone in a first step and added non-cognitive predictors in a second step. RESULTS Results revealed that the combination of cognitive and non-cognitive risk factors significantly predicted driving skills (R2adjusted = 0.30) and fitness to drive (81.2% accuracy) as well as the number (R2adjusted = 0.21) and occurrence (88.3% accuracy) of prospective minor at-fault accidents within the next 12 months. In all analyses, the inclusion of non-cognitive risk factors led to a significant increase of explained variance in the different outcome variables. CONCLUSION Our findings suggest that a combination of the most robust cognitive and non-cognitive risk factors may allow an economic and accurate prediction of on-road driving performance and prospective accident risk in healthy older drivers and drivers with MCI. Therefore, non-cognitive risk factors appear to play an important role.
Collapse
Affiliation(s)
- Max Toepper
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Philipp Schulz
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Thomas Beblo
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Martin Driessen
- Evangelisches Klinikum Bethel (EvKB), Department of Psychiatry and Psychotherapy, Bielefeld, Germany
| |
Collapse
|
6
|
Yuen NH, Tam F, Churchill NW, Schweizer TA, Graham SJ. Driving With Distraction: Measuring Brain Activity and Oculomotor Behavior Using fMRI and Eye-Tracking. Front Hum Neurosci 2021; 15:659040. [PMID: 34483861 PMCID: PMC8415783 DOI: 10.3389/fnhum.2021.659040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Driving motor vehicles is a complex task that depends heavily on how visual stimuli are received and subsequently processed by the brain. The potential impact of distraction on driving performance is well known and poses a safety concern - especially for individuals with cognitive impairments who may be clinically unfit to drive. The present study is the first to combine functional magnetic resonance imaging (fMRI) and eye-tracking during simulated driving with distraction, providing oculomotor metrics to enhance scientific understanding of the brain activity that supports driving performance. Materials and Methods As initial work, twelve healthy young, right-handed participants performed turns ranging in complexity, including simple right and left turns without oncoming traffic, and left turns with oncoming traffic. Distraction was introduced as an auditory task during straight driving, and during left turns with oncoming traffic. Eye-tracking data were recorded during fMRI to characterize fixations, saccades, pupil diameter and blink rate. Results Brain activation maps for right turns, left turns without oncoming traffic, left turns with oncoming traffic, and the distraction conditions were largely consistent with previous literature reporting the neural correlates of simulated driving. When the effects of distraction were evaluated for left turns with oncoming traffic, increased activation was observed in areas involved in executive function (e.g., middle and inferior frontal gyri) as well as decreased activation in the posterior brain (e.g., middle and superior occipital gyri). Whereas driving performance remained mostly unchanged (e.g., turn speed, time to turn, collisions), the oculomotor measures showed that distraction resulted in more consistent gaze at oncoming traffic in a small area of the visual scene; less time spent gazing at off-road targets (e.g., speedometer, rear-view mirror); more time spent performing saccadic eye movements; and decreased blink rate. Conclusion Oculomotor behavior modulated with driving task complexity and distraction in a manner consistent with the brain activation features revealed by fMRI. The results suggest that eye-tracking technology should be included in future fMRI studies of simulated driving behavior in targeted populations, such as the elderly and individuals with cognitive complaints - ultimately toward developing better technology to assess and enhance fitness to drive.
Collapse
Affiliation(s)
- Nicole H Yuen
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Nathan W Churchill
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| |
Collapse
|
7
|
Spargo C, Laver K, Berndt A, Adey-Wakeling Z, George S. Occupational Therapy Interventions to Improve Driving Performance in Older People With Mild Cognitive Impairment or Early-Stage Dementia: A Systematic Review. Am J Occup Ther 2021; 75:14134. [PMID: 34780644 DOI: 10.5014/ajot.2021.042820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE For a person with mild cognitive impairment (MCI) or early-stage dementia, driving is important for independence. However, driving presents safety concerns for both the person and family members. It is important to determine whether occupational therapy interventions can prolong safe driving for this population. OBJECTIVE To determine the effectiveness of occupational therapy interventions to improve driving performance in older people with MCI or early-stage dementia. DATA SOURCES We conducted a search of MEDLINE, PsycINFO, CINAHL, and gray literature using Google Scholar. Study Selection and Data Collection: Studies were included if they evaluated interventions that (1) aimed to improve the driving performance of older people (M age ≥60 yr) with MCI or early-stage dementia and (2) could be designed or delivered by an occupational therapy practitioner who specializes in driving. Citations were reviewed independently by two authors, and quality appraisal was conducted using the Cochrane risk-of-bias guidelines. FINDINGS One Level I randomized controlled trial (RCT) and 4 Level III quasi-experimental studies were included; these studies had 231 participants in total with reported M ages of 65.6-72.5 yr. One study evaluated a compensatory approach, whereas the others evaluated a remedial approach. The studies used different measures to assess outcomes and reported mixed effects. CONCLUSIONS AND RELEVANCE Low strength of evidence suggests that occupational therapy interventions may improve the driving performance of older people with MCI or early-stage dementia. More RCTs are needed that include long-term follow-up measures and address clinically important outcomes. What This Article Adds: In the absence of conclusive evidence from research studies and best practice guidelines, occupational therapy practitioners must rely on their clinical experience and their clients' abilities. Development of evidence and guidelines in this area is critical. It is also important for practitioners to work closely with clients, families, and interdisciplinary team members to carefully monitor fitness to drive.
Collapse
Affiliation(s)
- Claire Spargo
- Claire Spargo, MOccTh, BBehavSc, is PhD candidate, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- Kate Laver, PhD, MClinRehab, is Associate Professor, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Angela Berndt
- Angela Berndt, PhD, BAppSc (OT), is Occupational Therapy Program Director, University of South Australia, Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Zoe Adey-Wakeling
- Zoe Adey-Wakeling, PhD, BMBS, FAFRM (RACP), AFRACMA, is Senior Lecturer, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, and Senior Rehabilitation Consultant, Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Stacey George
- Stacey George, PhD, BAppSc (OT), MHSc (OT), is Professor of Occupational Therapy, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia;
| |
Collapse
|
8
|
Huang V, Hogan DB, Ismail Z, Maxwell CJ, Smith EE, Callahan BL. Evaluating the Real-World Representativeness of Participants with Mild Cognitive Impairment in Canadian Research Protocols: a Comparison of the Characteristics of a Memory Clinic Patients and Research Samples. Can Geriatr J 2020; 23:297-328. [PMID: 33282050 PMCID: PMC7704078 DOI: 10.5770/cgj.23.416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Studies of mild cognitive impairment (MCI) employ rigorous eligibility criteria, resulting in sampling that may not be representative of the broader clinical population. Objective To compare the characteristics of MCI patients in a Calgary memory clinic to those of MCI participants in published Canadian studies. Methods Clinic participants included 555 MCI patients from the PROspective Registry of Persons with Memory SyMPToms (PROMPT) registry in Calgary. Research participants included 4,981 individuals with MCI pooled from a systematic literature review of 112 original, English-language peer-reviewed Canadian studies. Both samples were compared on baseline sociodemographic variables, medical and psychiatric comorbidities, and cognitive performance for MCI due to Alzheimer’s disease and Parkinson’s disease. Results Overall, clinic patients tended to be younger, more often male, and more educated than research participants. Psychiatric disorders, traumatic brain injury, and sensory impairment were commonplace in PROMPT (up to 83% affected) but > 80% studies in the systematic review excluded these conditions. PROMPT patients also performed worse on global cognition measures than did research participants. Conclusion Stringent eligibility criteria in Canadian research studies excluded a considerable subset of MCI patients with comorbid medical or psychiatric conditions. This exclusion may contribute to differences in cognitive performance and outcomes compared to real-world clinical samples.
Collapse
Affiliation(s)
- Vivian Huang
- Department of Psychology, Ryerson University, Toronto, ON
| | - David B Hogan
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Colleen J Maxwell
- Hotchkiss Brain Institute, Calgary, AB.,Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, ON
| | - Eric E Smith
- Cumming School of Medicine, University of Calgary, Calgary, AB.,Hotchkiss Brain Institute, Calgary, AB
| | - Brandy L Callahan
- Hotchkiss Brain Institute, Calgary, AB.,Mathison Centre for Mental Health Research & Education, Calgary, AB.,Department of Psychology, University of Calgary, Calgary, AB
| |
Collapse
|
9
|
Falkenstein M, Karthaus M, Brüne-Cohrs U. Age-Related Diseases and Driving Safety. Geriatrics (Basel) 2020; 5:E80. [PMID: 33086572 PMCID: PMC7709672 DOI: 10.3390/geriatrics5040080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
Collapse
Affiliation(s)
- Michael Falkenstein
- Institute for Work Learning and Aging (ALA), Hiltroper Landwehr 136, 44805 Bochum, Germany
| | - Melanie Karthaus
- Leibniz Institute for Working Environment and Human Factors (IfADo), 44139 Dortmund, Germany;
| | - Ute Brüne-Cohrs
- LWL University Hospital, Clinic for Psychiatry, Psychotherapy and Preventive Medicine, 44791 Bochum, Germany;
| |
Collapse
|
10
|
Abstract
ZusammenfassungDie Verkehrsmedizin als Teil der Rechtsmedizin erfüllt in der Schweiz eine wichtige präventive Aufgabe in der Sicherung aller Verkehrsteilnehmer: Sie begutachtet die medizinisch basierte Fahrfähigkeit und Fahreignung. Als empirisch konsolidiertes Querschnittsfach hat sie Informationen aus einer Vielzahl von medizinischen Fachgebieten. Wie reagiert die Verkehrsmedizin aber auf den vermehrten Anspruch evidenzbasierter Gutachten und auf anstehende Herausforderungen?Über einen historischen Abriss motivierten wir die Vorteile und das Potential einer teilweise durch Fahrsimulation ergänzten Untersuchung und einer dediziert auf Fahrsimulation basierenden, klinisch-prospektiven Forschung.Neben vorhandener Literatur stützen sich historische Aspekte u.a. auf vorhandene Expertise. Die Bewertung der Fahrsimulation für die Verkehrs- bzw. Rechtsmedizin der Schweiz stützt sich auf die Diskussion selektierter Literatur.Auftrag und Anspruch der Verkehrsmedizin haben sich mehrfach verändert. Eine übersichtsartige Betrachtung existenter Literatur legt nahe, dass massgeschneiderte Fahrsimulatoren Teil einer modernisierten Verkehrsmedizin sein können, um anstehende Herausforderungen adäquat adressieren zu können. Bisher existiert kein derartiges dediziertes Forschungsinstrument in der Schweiz.Eine auf verkehrsmedizinische Fragestellungen massgeschneiderte, realitätsnahe und niedrigschwellige Fahrsimulation als Werkzeug für klinische Studien und Individualuntersuchungen verspricht neben einer wissenschaftlichen Produktivität einen umsetzbaren und vermittelbaren Mehrwert für das übergeordnete Ziel der Sicherheit aller Verkehrsteilnehmer.
Collapse
|
11
|
Eramudugolla R, Huque MH, Wood J, Anstey KJ. On-Road Behavior in Older Drivers With Mild Cognitive Impairment. J Am Med Dir Assoc 2020; 22:399-405.e1. [PMID: 32698991 DOI: 10.1016/j.jamda.2020.05.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Dementia increases the risk of unsafe driving, but this is less apparent in preclinical stages such as mild cognitive impairment (MCI). There is, however, limited detailed data on the patterns of driving errors associated with MCI. Here, we examined whether drivers with MCI exhibited different on-road error profiles compared with cognitively normal (CN) older drivers. DESIGN Observational. SETTING AND PARTICIPANTS A total of 296 licensed older drivers [mean age 75.5 (SD = 6.2) years, 120 (40.5%) women] recruited from the community. METHOD Participants completed a health and driving history survey, a neuropsychological test battery, and an on-road driving assessment including driver-instructed and self-navigation components. Driving assessors were blind to participant cognitive status. Participants were categorized as safe or unsafe based on a validated on-road safety scale, and as having MCI based on International Working Group diagnostic criteria. Proportion of errors incurred as a function of error type and traffic context were compared across safe and unsafe MCI and CN drivers. RESULTS Compared with safe CN drivers (n = 225), safe MCI drivers (n = 45) showed a similar pattern of errors in different traffic contexts. Compared with safe CN drivers, unsafe CN drivers (n = 17) were more likely to make errors in observation, speed control, lane position, and approach, and at stop/give-way signs, lane changes, and curved driving. Unsafe MCI drivers (n = 9) had additional difficulties at intersections, roundabouts, parking, straight driving, and under self-navigation conditions. A higher proportion of unsafe MCI drivers had multidomain subtype [n = 6 (67%)] than safe MCI drivers [n = 11 (25%)], odds ratio 6.2 (95% confidence interval, 1.4-29.6). CONCLUSION AND IMPLICATIONS Among safe drivers, MCI and CN drivers exhibit similar on-road error profiles, suggesting driver restrictions based on MCI status alone are unwarranted. However, formal evaluation is recommended in such cases, as there is evidence drivers with multiple domains of cognitive impairment may require additional interventions to support safe driving.
Collapse
Affiliation(s)
- Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Randwick, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Md Hamidul Huque
- School of Psychology, University of New South Wales, Randwick, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Joanne Wood
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, Institute of Health and Biomedical Innovation, Brisbane, QLD, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Randwick, NSW, Australia; Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia.
| |
Collapse
|
12
|
Toepper M, Falkenstein M. Driving Fitness in Different Forms of Dementia: An Update. J Am Geriatr Soc 2019; 67:2186-2192. [PMID: 31386780 DOI: 10.1111/jgs.16077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Most forms of dementia are associated with progressive cognitive and noncognitive impairments that can severely affect fitness to drive. Whether safe driving is still possible in the single case, however, is often difficult to decide and may be dependent on both severity and type of the respective dementia syndrome. Particularly in early disease stages, Alzheimer disease dementia (ADD) and different types of non-Alzheimer dementias, such as vascular dementia (VaD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and Parkinson disease dementia (PDD), might differentially affect fitness to drive. DESIGN To examine the effects of severity and type of dementia on driving fitness, we conducted a systematic review with qualitative narrative synthesis, involving different driving outcomes in different forms and stages of dementia. SETTING Literature research included MEDLINE and PsycINFO databases with a focus on the most relevant and recent publications on the topic. PARTICIPANTS The population of interest included older drivers in different stages of ADD and different forms of non-Alzheimer dementias (VaD, FTD, DLB, and PDD). MEASUREMENTS Narrative description of driving outcomes in the population of interest. RESULTS Overall, previous studies suggest that driving fitness is severely impaired in moderate and severe dementia, irrespective of the type of dementia. In milder disease stages, fitness to drive appears to be more severely impaired in non-Alzheimer dementias than in ADD, since the non-Alzheimer syndromes are not only associated with driving-relevant cognitive but noncognitive risk factors, such as behavioral or motor symptoms. CONCLUSIONS Based on these findings, practical recommendations are presented, including a risk evaluation for driving safety, depending on severity and type of different dementia syndromes. J Am Geriatr Soc 67:2186-2192, 2019.
Collapse
Affiliation(s)
- Max Toepper
- Evangelisches Klinikum Bethel, Research Division, Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany.,Evangelisches Klinikum Bethel, Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany
| | | |
Collapse
|
13
|
Yamasaki T, Tobimatsu S. Driving Ability in Alzheimer Disease Spectrum: Neural Basis, Assessment, and Potential Use of Optic Flow Event-Related Potentials. Front Neurol 2018; 9:750. [PMID: 30245666 PMCID: PMC6137098 DOI: 10.3389/fneur.2018.00750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
Driving requires multiple cognitive functions including visuospatial perception and recruits widespread brain networks. Recently, traffic accidents in dementia, particularly in Alzheimer disease spectrum (ADS), have increased and become an urgent social problem. Therefore, it is necessary to develop the objective and reliable biomarkers for driving ability in patients with ADS. Interestingly, even in the early stage of the disease, patients with ADS are characterized by the impairment of visuospatial function such as radial optic flow (OF) perception related to self-motion perception. For the last decade, we have studied the feasibility of event-related potentials (ERPs) in response to radial OF in ADS and proposed that OF-ERPs provided an additional information on the alteration of visuospatial perception in ADS (1, 2). Hence, we hypothesized that OF-ERPs can be a possible predictive biomarker of driving ability in ADS. In this review, the recent concept of neural substrates of driving in healthy humans are firstly outlined. Second, we mention the alterations of driving performance and its brain network in ADS. Third, the current status of assessment tools for driving ability is stated. Fourth, we describe ERP studies related to driving ability in ADS. Further, the neural basis of OF processing and OF-ERPs in healthy humans are mentioned. Finally, the application of OF-ERPs to ADS is described. The aim of this review was to introduce the potential use of OF-ERPs for assessment of driving ability in ADS.
Collapse
Affiliation(s)
- Takao Yamasaki
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, Minkodo Minohara Hospital, Fukuoka, Japan
| | - Shozo Tobimatsu
- Department of Clinical Neurophysiology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
14
|
Hird MA, Churchill NW, Fischer CE, Naglie G, Graham SJ, Schweizer TA. Altered Functional Brain Connectivity in Mild Cognitive Impairment during a Cognitively Complex Car Following Task. Geriatrics (Basel) 2018; 3:geriatrics3020020. [PMID: 31011061 PMCID: PMC6319210 DOI: 10.3390/geriatrics3020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022] Open
Abstract
Mild cognitive impairment (MCI) can affect multiple cognitive abilities, leading to difficulty in performing complex, cognitively demanding daily tasks, such as driving. This study combined driving simulation and functional magnetic resonance imaging (fMRI) to investigate brain function in individuals with MCI while they performed a car-following task. The behavioral driving performance of 24 patients with MCI and 20 healthy age-matched controls was compared during a simulated car-following task. Functional brain connectivity during driving was analyzed for a separate cohort of 15 patients with MCI and 15 controls. Individuals with MCI had minor difficulty with lane maintenance, exhibiting significantly increased variability in steering compared to controls. Patients with MCI also exhibited reduced connectivity between fronto-parietal regions, as well as between regions involved in cognitive control (medial frontal cortex) and regions important for visual processing (cuneus, angular gyrus, superior occipital cortex, inferior and superior parietal cortex). Greater difficulty in lane maintenance (i.e., increased steering variability and lane deviations) among individuals with MCI was further associated with increased connectivity between the posterior cingulate cortex (PCC) and inferior frontal gyrus, as well as increased intra-cerebellar connectivity. Thus, compared to cognitively healthy controls, patients with MCI showed reduced connectivity between regions involved in visual attention, visual processing, cognitive control, and performance monitoring. Greater difficulty with lane maintenance among patients with MCI may reflect failure to inhibit components of the default-mode network (PCC), leading to interference with task-relevant networks as well as alterations in cerebellum connectivity.
Collapse
Affiliation(s)
- Megan A Hird
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada.
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
| | - Nathan W Churchill
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada.
| | - Corinne E Fischer
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada.
- Department of Psychiatry, Division of Geriatric Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada.
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Science, Toronto, ON M6A 2E1, Canada.
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A8, Canada.
- Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
| | - Simon J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada.
| | - Tom A Schweizer
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada.
- Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, ON M52 3H7, Canada.
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada.
| |
Collapse
|
15
|
Seelye A, Mattek N, Sharma N, Witter P, Brenner A, Wild K, Dodge H, Kaye J. Passive Assessment of Routine Driving with Unobtrusive Sensors: A New Approach for Identifying and Monitoring Functional Level in Normal Aging and Mild Cognitive Impairment. J Alzheimers Dis 2018; 59:1427-1437. [PMID: 28731434 DOI: 10.3233/jad-170116] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Driving is a key functional activity for many older adults, and changes in routine driving may be associated with emerging cognitive decline due to early neurodegenerative disease. Current methods for assessing driving such as self-report are inadequate for identifying and monitoring subtle changes in driving patterns that may be the earliest signals of functional change in developing mild cognitive impairment (MCI). OBJECTIVE This proof of concept study aimed to establish the feasibility of continuous driving monitoring in a sample of cognitively normal and MCI older adults for an average of 206 days using an unobtrusive driving sensor and demonstrate that derived sensor-based driving metrics could effectively discriminate between MCI and cognitively intact groups. METHODS Novel objective driving measures derived from 6 months of routine driving monitoring were examined in older adults with intact cognition (n = 21) and MCI (n = 7) who were enrolled in the Oregon Center for Aging and Technology (ORCATECH) longitudinal assessment program. RESULTS Unobtrusive continuous monitoring of older adults' routine driving using a driving sensor was feasible and well accepted. MCI participants drove fewer miles and spent less time on the highway per day than cognitively intact participants. MCI drivers showed less day-to-day fluctuations in their driving habits than cognitively intact drivers. CONCLUSION Sensor-based driving measures are objective, unobtrusive, and can be assessed every time a person drives his or her vehicle to identify clinically meaningful changes in daily driving. This novel methodology has the potential to be useful for the early detection and monitoring of changes in daily functioning within individuals.
Collapse
Affiliation(s)
- Adriana Seelye
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA.,Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Nora Mattek
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA
| | - Nicole Sharma
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA
| | - Phelps Witter
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA
| | - Ariella Brenner
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA
| | - Katherine Wild
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA
| | - Hiroko Dodge
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA.,Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Oregon Center for Aging and Technology, Oregon Health and Science University, Portland, OR, USA.,Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
16
|
Driving habits and behaviors of patients with brain tumors: a self-report, cognitive and driving simulation study. Sci Rep 2018; 8:4635. [PMID: 29545606 PMCID: PMC5854700 DOI: 10.1038/s41598-018-22937-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/05/2018] [Indexed: 01/13/2023] Open
Abstract
The purpose of the study is to determine driving habits and behaviors of patients with brain tumors in order to better inform discussions around driving safety in this population. Eight-four patients with brain tumors participated in a survey on their driving behaviors since their diagnosis. Thirteen of these patients and thirteen sex- and age-matched healthy controls participated in cognitive testing and several driving simulation scenarios in order to objectively assess driving performance. Survey responses demonstrated that patients with brain tumors engage in a variety of driving scenarios with little subjectve difficulty. On the driving simulation tasks, patients and healthy controls performed similarly except that patients had more speed exceedances (U = 41, p < 0.05) and a greater variability in speed (U = 57, p < 0.05). Performance on the selective attention component of the UFOV was significantly associated with greater total errors in the Bus Following task for patients with brain tumors compared to healthy controls (rs = 0.722, p < 0.05, CI [0.080, 0.957]). Better comprehensive driving assessments are needed to identify patients with driving behaviors that put themselves and others at risk on the road.
Collapse
|