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Bassingthwaighte L, Gustafsson L, Molineux M, Bell R, Pinzon Perez W, Shah D. On-road driving remediation following acquired brain injury: a randomized controlled trial. Brain Inj 2024:1-12. [PMID: 38994668 DOI: 10.1080/02699052.2024.2376763] [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: 02/10/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To investigate the relationship between on-road driving remediation and achieving fitness to drive following acquired brain injury. DESIGN Randomized controlled trial. SETTING Tertiary hospital outpatient driver assessment and rehabilitation service, Australia. PARTICIPANTS Thirty-five participants (54.3% male), aged 18-65 years, 41 days-20 years post-acquired brain injury (including stroke, aneurysm, traumatic brain injury) recommended for on-road driving remediation following occupational therapy driver assessment were randomly assigned to intervention (n = 18) and waitlist control (n = 17) groups. INTERVENTION Intervention group received on-road driving remediation delivered by a qualified driving instructor in a dual-control vehicle. The waitlist control group completed a 6 week period of no driving-related remediation. MAIN MEASURE Fitness to drive rated following the conduct of an on-road occupational therapy driver assessment with a qualified driving instructor where outcome assessors were blinded to group allocation. RESULTS The intervention group were significantly more likely to achieve a fit to drive recommendation than no driving specific intervention (p = 0.003). CONCLUSION Following comprehensive assessment, individualized on-road driving remediation programs devised by an occupational therapist with advanced training in driver assessment and rehabilitation and delivered by a qualified driving instructor are significantly associated with achieving fitness to drive after acquired brain injury.
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Affiliation(s)
- Louise Bassingthwaighte
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Driving Assessment and Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Matthew Molineux
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Ryan Bell
- Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - William Pinzon Perez
- QCIF Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Darshan Shah
- Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, Griffith University, Nathan, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Takahashi A, Kitsunai S, Kawana H, Saito N, Yoshihara A, Furukawa K. Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report. Physiother Theory Pract 2024:1-15. [PMID: 38516762 DOI: 10.1080/09593985.2024.2332792] [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: 09/07/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements. PURPOSE This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS). CASE DESCRIPTION A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed. OUTCOMES The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability. CONCLUSION Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.
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Affiliation(s)
- Aisuke Takahashi
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Shun Kitsunai
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Hikaru Kawana
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Naoshi Saito
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Akioh Yoshihara
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Katsuhiro Furukawa
- Department of Physical Therapy, Faculty of Health Sciences, Iryo Sosei University, Fukushima, Japan
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Morrissey S, Jeffs S, Gillings R, Khondoker M, Patel M, Fisher-Morris M, Manley E, Hornberger M. The Impact of Spatial Orientation Changes on Driving Behavior in Healthy Aging. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad188. [PMID: 38134234 PMCID: PMC10872713 DOI: 10.1093/geronb/gbad188] [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: 06/30/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Global cognitive changes in older age affect driving behavior and road safety, but how spatial orientation differences affect driving behaviors is unknown on a population level, despite clear implications for driving policy and evaluation during aging. The present study aimed to establish how spatial navigation changes affect driving behavior and road safety within a large cohort of older adults. METHODS Eight hundred and four participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behavior followed by spatial orientation (allocentric and egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning). RESULTS Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behavior in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age. DISCUSSION We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future aging driving assessments, as it has clear relevance for road safety within the aging population.
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Affiliation(s)
- Sol Morrissey
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Stephen Jeffs
- Department of Psychology, University of Exeter, Exeter, UK
| | - Rachel Gillings
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Martyn Patel
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, UK
| | | | - Ed Manley
- School of Geography, University of Leeds, Leeds, UK
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Gårdinger MB, Johansson R, Lidestam B, Selander H. Validation of a computerized driving simulator test of cognitive abilities for fitness-to-drive assessments. Front Psychol 2024; 14:1294965. [PMID: 38259535 PMCID: PMC10800903 DOI: 10.3389/fpsyg.2023.1294965] [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: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background Driving requires a series of cognitive abilities, many of which are affected by age and medical conditions. The psychosocial importance of continued driving ushers the need for valid measurements in fitness-to-drive assessments. A driving simulator test could prove useful in these assessments, having greater face validity than other off-road tests and being more cost-effective and safer than ordinary on-road testing. The aim of this study was to validate a driving simulator test for assessment of cognitive ability in fitness-to-drive assessments. Methods The study included 67 healthy participants. Internal consistency of the simulator subtests was estimated. A correlation analysis between results on the simulator and the cognitive tests Trail Making Test (TMT) A and B and the Useful field of View test (UFOV) and multiple regression analysis were conducted. Finally, a comparison of results between age groups (>65 years) and (<65 years) was done. Results Results showed good internal consistency. Significant and moderate correlations were found for all reaction time in the simulator's subtests and UFOV 3, and all but two with TMT A. Lane positioning in the simulator showed significant and low to moderate correlations with UFOV 3 in all subtests. Reaction time and Double reaction time on subtest 3 were significantly correlated with UFOV 2 and UFOV 3 and TMT A, respectively. Test on Centerline (position) in subtest 3 as dependent variable was significantly correlated with UFOV 3. Significant means differences and large effect sizes between the age groups were found for all reaction time and lane positioning tests. Conclusion The findings of concurrent validity, especially with TMT A and UFOV 3 and its sensitivity for age-related differences, indicate potential for the simulator to be used as a complement in fitness-to-drive assessments. However, a clinical study is necessary to further examine its usefulness for patients with cognitive deficits.
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Affiliation(s)
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Björn Lidestam
- Swedish National Transport Research Institute, Linköping, Sweden
| | - Helena Selander
- Swedish National Transport Research Institute, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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de Almeida WM, Quintas JL, Trindade IOA, Pitta LSR, Louzada LL, Nóbrega OT, Camargos EF. Diagnosis of Alzheimer's dementia and vehicle driving restriction: a scoping review. Psychogeriatrics 2024; 24:138-144. [PMID: 37990411 DOI: 10.1111/psyg.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
There are doubts about vehicle driving restriction for patients with Alzheimer's disease. A scoping review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-ScR) methodology. Relevant databases were searched for articles published between 2000 and 2022 in English, Spanish, or Portuguese. Articles were included if they specifically addressed driving, risk of accidents, permission or licence to drive a motor vehicle in a context of important cognitive decline, or if addressed traffic legislation on driving and dementia. Twenty-three articles were selected for full reading, six of which were observational studies and only one with an interventionist method. All articles were carried out in high-income countries such as the UK, the US, and Australia. As a conclusion, there is no psychometric test in the literature sensitive enough to assess vehicle driving competence in older adults with cognitive deficits. Based on selected studies, there is no robust evidence to make recommendation for or against the cessation of vehicular driving for patients with mild cognitive decline or with mild dementia. In some situations, vehicle driving cessation can impact patients and their families. In addition, legal regulations regarding vehicle driving for older adults and people with dementia are scarce worldwide. Despite the scarcity of studies addressing the theme of vehicle driving in the context of dementia, there is some level of consensual reasoning that patients with moderate to severe dementia should halt driving activities, but the same does not apply for patients with mild levels of cognitive impairment, including mild dementia.
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Affiliation(s)
| | - Juliana Lima Quintas
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
| | | | | | - Luciana Lilian Louzada
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
| | - Otávio Toledo Nóbrega
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CR-IUGM), Montreal, Quebec, Canada
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Krasniuk S, Crizzle AM. Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers. Am J Occup Ther 2024; 78:7801205020. [PMID: 38215305 DOI: 10.5014/ajot.2024.050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
IMPORTANCE Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING A driving assessment clinic. PARTICIPANTS Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES On-road pass-fail outcomes. RESULTS Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.
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Affiliation(s)
- Sarah Krasniuk
- Sarah Krasniuk, PhD, MSc, is Postdoctoral Fellow, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander M Crizzle
- Alexander M. Crizzle, PhD, MPH, CE, is Associate Professor and Director, Driving Research and Simulation Laboratory, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
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Quintas JL, Trindade IOA, Gameiro KSD, Pitta LSR, Camargos EF, Nóbrega OT. Neuropsychological domains and fitness to drive in mild cognitive impairment or Alzheimer's disease. ACCIDENT; ANALYSIS AND PREVENTION 2023; 191:107188. [PMID: 37423139 DOI: 10.1016/j.aap.2023.107188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/11/2023]
Abstract
Cognitive deficits associated with mild cognitive impairment (MCI) or Alzheimer's disease (AD) can impact driving. This integrative review investigated which cognitive domains were associated with poor driving performance or unfitness to drive in studies with outcomes measured in simulator or on-road driving in patients with MCI or AD. The review was conducted by searching for articles published between 2001 and 2020 in the MEDLINE (via PubMed), EMBASE, and SCOPUS databases. Studies addressing patients with other dementias (e.g., vascular or mixed dementia, Lewy body dementia, Parkinson's disease) were excluded. Of 404 articles initially selected, 17 met the eligibility criteria for this review. Based on the findings of this integrative review, attentional capacity, processing speed, executive functions and visuospatial skills were the functions whose declines were most frequently reported in a context of unsafe driving by older adults with MCI or AD. Reports were remarkably heterogeneous in methodological aspects whereas quite limited in cross-cultural coverage and in sample recruited, what prompts for further trials in the field.
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Affiliation(s)
- Juliana Lima Quintas
- Hospital of the University of Brasilia (HUB), Medical Center for the Aged, Brasília, DF, Brazil
| | | | | | | | | | - Otávio Toledo Nóbrega
- Hospital of the University of Brasilia (HUB), Medical Center for the Aged, Brasília, DF, Brazil; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CR-IUGM), Montreal, QC, Canada.
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Gonzalez J, Patel N, Ownby RL. Cognitive function and impact on driving after SARS-COV-2 infection in a man with long-standing HIV infection: a case report. J Neurovirol 2023; 29:355-357. [PMID: 37160535 PMCID: PMC10169180 DOI: 10.1007/s13365-023-01143-1] [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: 10/05/2022] [Revised: 03/16/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
A substantial number of individuals who experience COVID-19 infection experience prolonged physical and mental symptoms after resolution of their initial infection, and among them, many individuals experience cognitive difficulties including memory lapses and executive function difficulties, often referred to as "brain fog." The possible impact of COVID-19 infection on cognition in persons with HIV-related cognitive disorders is unknown. In this report, we describe post-COVID-19 cognitive and driving function in a 62-year-old man with HIV infection since the early 1990s.
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Affiliation(s)
- Juan Gonzalez
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Center for Collaborative Research Suite 430, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
| | - Neil Patel
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Center for Collaborative Research Suite 430, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA
| | - Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Center for Collaborative Research Suite 430, 3301 College Avenue, Fort Lauderdale, FL, 33314, USA.
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Krasniuk S, Crizzle AM, Toxopeus R, Mychael D, Prince N. Clinical Tests Predicting On-Road Performance in Older Drivers with Cognitive Impairment. Can J Occup Ther 2023; 90:44-54. [PMID: 35950229 PMCID: PMC9923206 DOI: 10.1177/00084174221117708] [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] [Indexed: 11/15/2022]
Abstract
Background. The Trail Making Test Part B (Trails B) and Useful Field of View® (UFOV) can predict on-road outcomes in drivers with cognitive impairment (CI); however, studies have not included drivers referred for comprehensive driving evaluations (CDEs), who typically have more severe CI. Purpose. We determined the predictive ability of Trails B and UFOV on pass/fail on-road outcomes in drivers with CI (Montreal Cognitive Assessment <26) referred for CDEs. Method. Retrospective data collection from two driving assessments centers (N = 100, mean age = 76.2 ± 8.8 years). Findings. The Trails B (area under the curve [AUC] = .70) and UFOV subtests 2 (AUC = .73) and 3 (AUC = .76) predicted pass/fail outcomes. A cut-point ≥467 ms on UFOV subtest 3 better-predicted pass/fail outcomes with 78.9% sensitivity and 73.5% specificity. In comparison, a cut-point ≥3.58 min on Trails B had lower sensitivity (73.7%) and specificity (61.8%). Implications. The UFOV subtest 3 may be more useful than the Trails B for predicting pass/fail outcomes in drivers with more severe CI referred for CDEs.
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Affiliation(s)
| | - Alexander M. Crizzle
- Alexander Crizzle, School of Public Health,
University of Saskatchewan, Saskatoon, SK, Canada.
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Knoefel F, Hossain S, Hsu AT. Decline in Other Instrumental Activities of Daily Living as Indicators of Driving Risk in Older Adults at an Academic Memory Clinic. Geriatrics (Basel) 2023; 8:geriatrics8010007. [PMID: 36648912 PMCID: PMC9844285 DOI: 10.3390/geriatrics8010007] [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: 12/06/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Decisions around driving retirement are difficult for older persons living with cognitive decline and their caregivers. In many jurisdictions, physicians are responsible for notifying authorities of driving risks. However, there are no standardized guidelines for this assessment. Having access to a driving risk assessment tool could help older adults and their caregivers prepare for discussions around driving retirement. This study compares the clinical profiles of older adult drivers assessed in an academic memory clinic who were referred to the driving authority to older drivers who were not with a focus on instrumental activities of daily living (iADLs). METHODS Data on referred (R) and not-referred (NR) drivers were extracted from medical records. Elements from the medical history, cognitive history, functional abilities, Modified Mini-Mental State (3MS) examination, Trails A/B, and clock drawing were included in the analysis. Four risk factors of interest were examined in separate logistic regression analyses, adjusted for demographic variables. RESULTS 50 participants were identified in each group. The R group was older on average than the NR. As expected, R were more likely to have Trails B scores over 3 min and have significantly abnormal clock drawing tests. R also showed lower 3MS scores and a higher average number of functional impairments (including managing appointments, medications, bills, or the television). CONCLUSION Beyond standard cognitive tests, impairment in iADLs may help general practitioners identify at-risk drivers in the absence of standardized guidelines and tools. This finding can also inform the design of a risk assessment tool for driving and could help with approaches for drivers with otherwise borderline test results.
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Affiliation(s)
- Frank Knoefel
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
- Bruyère Continuing Care, Ottawa, ON K1N 5C8, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Department of Systems and Computer Engineering, Faculty of Engineering and Design, Carleton University, Ottawa, ON K1S 5B6, Canada
- AGE-WELL NIH—SAM3, Ottawa, ON K1N 5C8, Canada
- Correspondence: ; Tel.: +1-613-562-6322
| | - Shehreen Hossain
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Amy T. Hsu
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
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Khanafer S, Sveistrup H, Cressman EK. The Influence of Age on the Intermanual Transfer and Retention of Implicit Visuomotor Adaptation. J Mot Behav 2023; 55:220-235. [PMID: 36509430 DOI: 10.1080/00222895.2022.2156451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We examined age-related changes in intermanual transfer and retention of implicit visuomotor adaptation. We further asked if providing augmented somatosensory feedback regarding movement endpoint would enhance visuomotor adaptation. Twenty young adults and twenty older adults were recruited and randomly divided into an Augmented Feedback group and a Control group. All participants reached to five visual targets with visual feedback rotated 30° counter-clockwise relative to their actual hand motion. Augmented somatosensory feedback was provided at the end of the reach via the robotic handle that participants held. Implicit adaptation was assessed in the absence of visual feedback in the right trained hand and in the left untrained hand following rotated training trials to establish implicit adaptation and intermanual transfer of adaptation respectively. Participants then returned 24 hours later to assess retention in the trained and untrained hands. Results revealed that older adults demonstrated a comparable magnitude of implicit adaptation, transfer and retention of visuomotor adaptation as observed in younger adults, regardless of the presence of augmented somatosensory feedback. To conclude, when visuomotor adaptation is driven implicitly, intermanual transfer and retention do not differ significantly between young and older adults, even when the availability of augmented somatosensory feedback is manipulated.
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Affiliation(s)
- Sajida Khanafer
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Erin K Cressman
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
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Vander Veen A, Cammarata M, Renner S, Alvarez L. The Clinical Usefulness of the Practice Resource for Driving after Stroke (PReDAS). Occup Ther Health Care 2023; 37:119-144. [PMID: 34955088 DOI: 10.1080/07380577.2021.2018751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Occupational Therapists (OTs) have identified a critical need for organized, evidence-based resources to approach driving post-stroke. The Practice Resource for Driving After Stroke (PReDAS) is a resource to support the clinical reasoning and practice of health professionals for addressing driving in acute stroke care. The purpose of this pilot study is to evaluate the usefulness of the PReDAS to support clinician and patient decision-making about return to driving after stroke/Transient Ischemic Attack (TIA) in the acute care hospital setting. OTs, physicians, and patients diagnosed with stroke/TIA were surveyed regarding their experience with the PReDAS in acute care. Patient participants were also contacted for a follow-up questionnaire. OT, physician and patient stakeholders reported the PReDAS was useful to support decision-making for driving. The majority of patients recalled information provided in acute care and abstained from driving as advised. This study provides preliminary support for the clinical usefulness of the PReDAS.
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Affiliation(s)
- April Vander Veen
- Integrated Stroke Unit, Grand River Hospital, Kitchener, Canada.,Health and Rehabilitation Sciences, Faculty of Health Sciences London, Western University, London, Canada
| | - Michael Cammarata
- Department of Occupational Therapy, Buffalo, D'Youville College, New York, NY, USA
| | - Sarah Renner
- Integrated Stroke Unit, Grand River Hospital, Kitchener, Canada
| | - Liliana Alvarez
- School of Occupational Therapy, Western University, London, Canada
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Krasniuk S, Mychael D, Crizzle AM. Driving Errors Predicting Pass/Fail On-Road Assessment Outcomes Among Cognitively Impaired Older Drivers. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:144-153. [PMID: 35337241 PMCID: PMC9729977 DOI: 10.1177/15394492221076494] [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] [Indexed: 12/29/2022]
Abstract
Older drivers with cognitive impairment (CI)/dementia make significantly more driving errors than healthy controls; however, whether driving errors are predictive of pass/fail outcomes in older drivers with CI/dementia are unclear. This study determined the driving errors that predicted failing an on-road assessment in drivers with CI. We retrospectively collected comprehensive driving evaluation data of 80 participants (76.1 ± 9.3 years) from an Ontario driving assessment center. Adjustment to stimuli (area under the curve [AUC] = 0.88), lane maintenance (AUC = 0.84), and speed regulation errors (AUC = 0.85) strongly predicted pass/fail outcomes. Worse performance on the Trails B (time) and Useful Field of View® (Subtest 2, Subtest 3, and risk index) were significantly correlated with adjustment to stimuli (p < .05), lane maintenance (p < .05), and speed regulation errors (p < .05). Adjustment to stimuli, lane maintenance, and speed regulation errors may be critical indicators of failing an on-road assessment in older drivers with CI. Prioritizing these errors may help identify at-risk drivers.
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Affiliation(s)
| | | | - Alexander M. Crizzle
- University of Saskatchewan, Saskatoon, Canada,Alexander M. Crizzle, Associate Professor and Director of the Driving Research & Simulation Laboratory, School of Public Health, University of Saskatchewan, 104 Clinic Road, Saskatoon, Saskatchewan, Canada S7N 2Z4.
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14
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Ramos-Henderson M, Calderón C, Domic-Siede M. Education bias in typical brief cognitive tests used for the detection of dementia in elderly population with low educational level: a critical review. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36519252 DOI: 10.1080/23279095.2022.2155521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dementia is a significant decline in cognition that interfere with independent, daily functioning. Dementia is a syndrome caused by a myriad and include primary neurologic, neuropsychiatric, and medical conditions. It has been projected that the prevalence of dementia will triple in the elderly population by the year 2050. Despite the benefits of early diagnosis, there is an effective under-detection of around 62% of people with mild cognitive impairment (MCI) or dementia. One of the factors associated with this problem is that diagnostic techniques are affected by the educational level of those evaluated. This is an important aspect to consider in the use of brief cognitive tests for the detection of dementia. This review presents and critically analyzes the available evidence regarding the effect of educational level on the diagnostic utility of three of the most widely used tools in the clinical setting: the Mini-mental Test Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Addenbrooke's Cognitive Examination (ACE). Previous evidence shows that the tasks that require reading, writing, calculation, phonological fluency, and visuoconstruction are affected by educational level. These results lead to discourage the use of these tests in older people with less than 6 years of schooling. The development of brief cognitive tests appropriate for people with a low educational level is recommended. We posit that adequate cognitive tests should not consider tasks or items that resemble characteristics of academic contexts and should be more analogous to daily activities situations.
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Affiliation(s)
- Miguel Ramos-Henderson
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
- Centro de Investigación e Innovación en Gerontología Aplicada CIGAP, Facultad de Salud, Universidad Santo Tomás, Antofagasta, Chile
| | - Carlos Calderón
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
| | - Marcos Domic-Siede
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
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15
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Costello MC, Barco PP, Manning KJ, O'Brien KE. Older adult driving performance assessed under simulated and on-road conditions. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35570656 DOI: 10.1080/23279095.2022.2066533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Simulated driving offers a convenient test of driving ability for older drivers, although the viability of using simulated driving with this population is mixed. The relative weighting of the relevant perceptual, cognitive, and physical factors may vary between simulated and on-road driving. The current study was designed to assess this possibility. We conducted simulated and on-road driving tests of 61 older adults aged 66-92 years. To ensure that the driving performance was measured similarly between the two driving modalities, we employed the Record of Driving Errors (RODE) driving assessment system during both driving tests. Correlation and random weights analysis (RWA) results indicated only modest evidence of correspondence between the simulated and on-road driving performances. The primary factors operative in both simulated and on-road driving was Useful Field of View and a measure of basic cognition. Unique factors for simulated driving included a measure of physical mobility (Time-Up-and-Go) and spatial reasoning (Line), and for on-road driving included chronological age and sensorimotor processing (Trail-Making Task A). Chronological age was correlated primarily the on-road rather than simulated test, was greatly reduced with the inclusion of additional explanatory factors, and likely reflects driving efficiency rather than driving safety. We conclude that simulated driving in healthy older drivers can be beneficial for research purposes to assess cognitive and perceptual factors that underly driving effectiveness, although it cannot serve as a clear proxy for on-road driving.
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Affiliation(s)
| | - Peggy P Barco
- Washington University School of Medicine, St. Louis, WA, USA
| | - Kevin J Manning
- Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
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16
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Itotani K, Suganuma I, Fujita H. Are the Physical and Cognitive Functions of Older Adults Affected by Having a Driver's License?-A Pilot Study of Suburban Dwellers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084573. [PMID: 35457440 PMCID: PMC9032131 DOI: 10.3390/ijerph19084573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
Previous studies have frequently reported that those with a driver’s license have better physical and cognitive functions than those without. However, there are many people in the world who do not need or who cannot have a driver’s license. We hypothesized that if the non-driver’s license group had the same or better physical and cognitive functioning as the driver’s license group, they could lead healthy lives without the risk of functional decline or loss of functioning due to surrendering their licenses or giving up driving. The subjects were 47 community-dwelling older adults. We measured their physical function and cognitive function and performed psychological assessment via the following tests: grip strength, Timed Up and Go test, walking speed, Five Times Sit to Stand test, Functional Reach test, Two-Step Test, Mini-Mental State Examination, Trail Making Test, Modified Falls Efficacy Scale, Geriatric Depression Scale, and University of California Los Angeles Loneliness Scale. In previous studies, it has been said that having a driver’s license provides good physical, cognitive, and psychological functions. However, in this study, loneliness and executive function were strongly influenced by age and sex, and no direct relationship to a driver’s license was suggested. Rather, non-driver license holders may be relieved because there is no risk of accidents due to driving, and there is no possibility of a suddenly decline in physical or cognitive function due to revocation of a driver’s license.
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Affiliation(s)
- Keisuke Itotani
- Department of General Rehabilitation, Faculty of Allied Health Sciences, Yamato University, 2-5-1 Katayama-cho, Suita 564-0082, Osaka, Japan
- Correspondence: ; Tel.: +81-66-385-8010
| | - Ippei Suganuma
- Department of Occupational Therapy, Faculty of Health Sciences, Kyoto Tachibana University, 34 Oyakeyamada-cho, Yamashina-ku, Kyoto 607-8175, Japan;
| | - Hiroyuki Fujita
- Department of Physical Therapy, Faculty of Health Care, Osaka University of Human Sciences, 1-4-1 Shoujaku, Settsu 566-8510, Osaka, Japan;
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17
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Cohen S, Cummings J, Knox S, Potashman M, Harrison J. Clinical Trial Endpoints and Their Clinical Meaningfulness in Early Stages of Alzheimer's Disease. J Prev Alzheimers Dis 2022; 9:507-522. [PMID: 35841252 PMCID: PMC9843702 DOI: 10.14283/jpad.2022.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As the focus of Alzheimer's disease (AD) therapeutic development shifts to the early stages of the disease, the clinical endpoints used in drug trials, and how these might translate into clinical practice, are of increasing importance. The clinical meaningfulness of trial outcome measures is often unclear, with a lack of conclusive evidence as to how these measures correlate to changes in disease progression and treatment response. Clarifying this would benefit all, including patients, care partners, primary care providers, regulators, and payers, and would enhance our understanding of the relationship between clinical trial endpoints and assessments used in everyday practice. At present, there is a wide range of assessment tools used in clinical trials for AD and substantial variability in measures selected as endpoints across these trials. The aim of this review is to summarize the most commonly used assessment tools for early stages of AD, describe their use in clinical trials and clinical practice, and discuss what might constitute clinically meaningful change in these measures in relation to disease progression and treatment response.
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Affiliation(s)
- S. Cohen
- Toronto Memory Program, Toronto, ON, Canada
| | - J. Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), NV, USA
| | - S. Knox
- Biogen International GmbH, Baar, Switzerland
| | | | - J. Harrison
- Metis Cognition Ltd, Wiltshire, UK,Alzheimer Center, AU Medical Center, Amsterdam, the Netherlands,Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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18
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Vintimilla R, Balasubramanian K, Hall J, Johnson L, Bryant SO. Comparing Framingham risk score and cognitive performance in a Mexican American cohort. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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García-Rudolph A, García-Molina A, Opisso E, Tormos JM, Madai VI, Frey D, Bernabeu M. Neuropsychological Assessments of Patients With Acquired Brain Injury: A Cluster Analysis Approach to Address Heterogeneity in Web-Based Cognitive Rehabilitation. Front Neurol 2021; 12:701946. [PMID: 34434163 PMCID: PMC8380987 DOI: 10.3389/fneur.2021.701946] [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: 04/29/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to (1) apply cluster analysis techniques to mixed-type data (numerical and categorical) from baseline neuropsychological standard and widely used assessments of patients with acquired brain injury (ABI) (2) apply state-of-the-art cluster validity indexes (CVI) to assess their internal validity (3) study their external validity considering relevant aspects of ABI rehabilitation such as functional independence measure (FIM) in activities of daily life assessment (4) characterize the identified profiles by using demographic and clinically relevant variables and (5) extend the external validation of the obtained clusters to all cognitive rehabilitation tasks executed by the participants in a web-based cognitive rehabilitation platform (GNPT). We analyzed 1,107 patients with ABI, 58.1% traumatic brain injury (TBI), 21.8% stroke and 20.1% other ABIs (e.g., brain tumors, anoxia, infections) that have undergone inpatient GNPT cognitive rehabilitation from September 2008 to January 2021. We applied the k-prototypes algorithm from the clustMixType R package. We optimized seven CVIs and applied bootstrap resampling to assess clusters stability (fpc R package). Clusters' post hoc comparisons were performed using the Wilcoxon ranked test, paired t-test or Chi-square test when appropriate. We identified a three-clusters optimal solution, with strong stability (>0.85) and structure (e.g., Silhouette > 0.60, Gamma > 0.83), characterized by distinctive level of performance in all neuropsychological tests, demographics, FIM, response to GNPT tasks and tests normative data (e.g., the 3 min cut-off in Trail Making Test-B). Cluster 1 was characterized by severe cognitive impairment (N = 254, 22.9%) the mean age was 47 years, 68.5% patients with TBI and 22% with stroke. Cluster 2 was characterized by mild cognitive impairment (N = 376, 33.9%) mean age 54 years, 53.5% patients with stroke and 27% other ABI. Cluster 3, moderate cognitive impairment (N = 477, 43.2%) mean age 33 years, 83% patients with TBI and 14% other ABI. Post hoc analysis on cognitive FIM supported a significant higher performance of Cluster 2 vs. Cluster 3 (p < 0.001), Cluster 2 vs. Cluster 1 (p < 0.001) and Cluster 3 vs. Cluster 1 (p < 0.001). All patients executed 286,798 GNPT tasks, with performance significantly higher in Cluster 2 and 3 vs. Cluster 1 (p < 0.001).
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Affiliation(s)
- Alejandro García-Rudolph
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Alberto García-Molina
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Eloy Opisso
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Josep María Tormos
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | - Vince I. Madai
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
- Faculty of Computing, Engineering and the Built Environment, School of Computing and Digital Technology, Birmingham City University, Birmingham, United Kingdom
| | - Dietmar Frey
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Montserrat Bernabeu
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
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20
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Yamin S, Ranger V, Stinchcombe A, Knoefel F, Gagnon S, Bédard M. Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment. Occup Ther Health Care 2020; 38:5-25. [PMID: 33249934 DOI: 10.1080/07380577.2020.1843750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022]
Abstract
Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.
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Affiliation(s)
- Stephanie Yamin
- Faculty of Human Sciences, Saint Paul University (Ottawa), Ottawa, ON, Canada
- Bruyere Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
| | - Valerie Ranger
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Arne Stinchcombe
- Department of Recreation and Leisure Studies, Brock University, Saint Catharines, ON, Canada
| | - Frank Knoefel
- Bruyere Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
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21
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Kavouras C, Economou A, Liozidou A, Kiosseoglou G, Yannis G, Kosmidis MH. Off-road assessment of cognitive fitness to drive. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:775-785. [PMID: 32905706 DOI: 10.1080/23279095.2020.1810041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Road safety is a major issue in every society. The assessment of driving ability with a real vehicle is a lengthy and costly process; therefore, there is a growing need for the development of a neuropsychological battery that can provide a fast and reliable evaluation of a person's cognitive fitness to drive. In the present study, we examined the relationship of an off-road lab-type test, namely, the Driving Scenes test, with performance on a driving simulator, as well as the influence of cognitive factors on driving ability as evaluated by Driving Scenes. Our results demonstrated a relationship between Driving Scenes and driving simulator performance. They also showed that some cognitive factors (namely, selective attention and verbal memory), were predictive of driving ability (as determined by the Driving Scenes test), but not others (namely visuospatial perception/memory, working memory, and visuospatial recognition). In addition, age strongly predicted performance on this test (younger age was associated with better performance). The conclusions derived from the present study highlight the need to identify off-road tools with high predictive value in assessing driving ability.
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Affiliation(s)
- Charalampos Kavouras
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Liozidou
- Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece.,Psychology Department, The Scientific College of Greece, Athens, Greece
| | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Yannis
- Department of Transportation Planning and Engineering, National Technical University of Athens - Zografou Campus, Zografou, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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22
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Li Y, Pi HC, Yang ZK, Dong J. Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis. J Nephrol 2020; 33:839-848. [PMID: 31643008 PMCID: PMC7381472 DOI: 10.1007/s40620-019-00661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/03/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Uremic toxins have been suspected as potential contributors for cognitive impairment in peritoneal dialysis (PD) patients. However, associations between the clearance of serum small and middle molecules and the change of cognitive function were not fully explored and then we explored this issue in the present study. METHOD A total of clinically-stable 222 patients on PD were enrolled and then followed up for 2 years in this single-center prospective cohort study. Small and middle molecules clearances were examined by urea clearance (Kt/V), creatinine clearance (Ccr) and beta-2 microglobulin (B2M) clearance via dialysate and urine at baseline and after 2 years. Global and specific cognitive impairment were measured at baseline and after 2 years. Modified Mini-Mental State Examination (3MS) was assessed for global cognitive function, trail-making tests A and B for executive function and subtests of the battery for the assessment of neuropsychological status for immediate and delayed memory, visuospatial skills and language ability. RESULTS The median of total Kt/V, Ccr and B2M clearance were 1.89, 53.2 l/w/1.73 m2 and 17.5 l/w/1.73 m2, respectively at baseline. The prevalence of global cognitive impairment was 12.3% for 222 patients and 15.4% for the remained 130 patients after 2 years. At baseline, total Kt/V was independently positively associated with delayed memory function. Total and dialysate beta-2 microglobulin clearance was positively associated with 3MS scores and negatively with completion time on trail A after multivariate adjustment. At 2 years, we observed a significant difference in the changing trend of 3MS scores between groups divided by total B2M clearance (P = 0.033), which still maintained to be meaningful after multivariate adjustment (P = 0.024). Patients with total B2M clearance > 19.0 l/w/1.73 m2 got significant improvement on their 3MS scores (P = 0.005). Patients divided by total Kt/V or Ccr were not significantly different in the trends of general and any specific cognitive function during the follow up. CONCLUSION The higher middle molecules clearance independently correlated to better performance on general cognitive and executive function in PD patients, which also predict an improvement in general cognitive function during the follow up.
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Affiliation(s)
- Yi Li
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
- Renal Division, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hai-Chen Pi
- Emergency Department, Peking University First Hospital, Beijing, China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education, Beijing, 100034, China.
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23
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Frank C, John PS, Molnar F. Screening tools for virtual assessment of cognition. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:502-503. [PMID: 32675095 PMCID: PMC7365161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Philip St John
- Head of the Section of Geriatric Medicine in the Max Rady College of Medicine and Associate Professor in the Centre on Aging at the University of Manitoba in Winnipeg
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24
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Frank C, John PS, Molnar F. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e185-e186. [PMID: 32675106 PMCID: PMC7365164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Philip St John
- Directeur de la Section de médecine gériatrique au Collège de médecine Max Rady et professeur agrégé au Centre sur le vieillissement de l'Université du Manitoba à Winnipeg
| | - Frank Molnar
- Spécialiste en médecine gériatrique à Ottawa (Ontario)
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25
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Egeland J, Follesø K. Offering alphabet support in the Trail Making Test: Increasing validity for participants with insufficient automatization of the alphabet. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:478-485. [PMID: 32546072 DOI: 10.1080/23279095.2020.1774377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Insufficient automatization of the alphabet may falsely impair performance on the Trail Making Test among persons with dyslexia or persons not accustomed to the Latin alphabet. We analyze whether writing the alphabet on top of the test sheet changes performance in these risk groups, and whether alphabet support reduces the complexity of the set-shifting task.One-hundred and seventy patients referred to neuropsychological assessment participated and were given both a TMT-version offering alphabet support and the D-KEFS TMT. The discrepancy between the D-KEFS subtask where lines are drawn successively between numbers only, and the task where lines are drawn between letters only, was operationalized as measuring insufficient alphabet automatization.Both the possible dyslexia group, and persons taught to read with another alphabet, had a larger discrepancy score than the remaining sample. Regression analyses showed that the discrepancy scores explained 3.4% of the variance beyond age and speed when giving alphabet support. The corresponding percentage for the D-KEFS Switching task was 17.5%. The findings indicate that alphabet support alleviated effects of non-automatization. The TMT-B-NR: TMT-A ratio score was equivalent to what is found when not applying alphabet support, showing that alphabet support did not contaminate the test as a EF-measure.
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Affiliation(s)
- Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
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26
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Lund P, Moir C, Kristalovich L, Ben Mortenson W. Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning. Am J Occup Ther 2020; 74:7401185040p1-7401185040p7. [PMID: 32078509 DOI: 10.5014/ajot.2019.032052] [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 The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. OBJECTIVE To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse. DESIGN This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. SETTING Rehabilitation hospital. PARTICIPANTS Forty-one patients with neurological impairments. OUTCOMES AND MEASURES The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). RESULTS The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029). CONCLUSIONS AND RELEVANCE The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. WHAT THIS ARTICLE ADDS This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.
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Affiliation(s)
- Paige Lund
- Paige Lund, BSc, MOT, is Occupational Therapist, Family Resource Association, Parksville, British Columbia, Canada
| | - Caitlyn Moir
- Caitlyn Moir, BA, MOT, is Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lisa Kristalovich
- Lisa Kristalovich, BMR (OT), MRSc, is Clinical Faculty, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada, and Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, BScOT, MSc, PhD, is Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Principal Investigator, Rehabilitation Research Program, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada; and Principal Investigator, International Collaboration on Repair Discoveries, VCHRI, Vancouver, British Columbia, Canada;
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27
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Hill LJN, Pignolo RJ, Tung EE. Assessing and Counseling the Older Driver: A Concise Review for the Generalist Clinician. Mayo Clin Proc 2019; 94:1582-1588. [PMID: 31378232 DOI: 10.1016/j.mayocp.2019.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/06/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022]
Abstract
Older drivers are putting more miles on the road during their "golden years" than generations prior. Many older adults have safe driving habits, but unique age-related changes increase the risk for crash-related morbidity and mortality. Generalists are poised to assess and guide older adults' driving fitness. Although there is no uniformly accepted tool for driving fitness, assessment of 5 key domains (cognition, vision, physical function, medical comorbidities, and medications) using valid tools can help clinicians stratify older drivers into low, intermediate, and high risk for unsafe driving. Clinicians can then make recommendations about fitness to drive and appropriate referrals for rehabilitation or alternative transportation resources to optimize mobility, independence, and quality of life for older adults.
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Affiliation(s)
- Larisa J N Hill
- Mayo Clinic School of Graduate Medical Education, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Robert J Pignolo
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Ericka E Tung
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Community Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
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Samuelsson K, Tropp M, Lundqvist A, Wressle E. Development, concurrent validity and internal consistency of a simulator tool for assessing continued car driving after a brain injury/disease. Br J Occup Ther 2019. [DOI: 10.1177/0308022619836935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Tropp
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Lundqvist
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ewa Wressle
- Department of Acute Internal Medicine and Geriatrics and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
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Lund P, Moir C, Kristalovich L, Ben Mortenson W. Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning. Am J Occup Ther 2019; 74:7401185040p1-7401185040p7. [PMID: 34781361 DOI: 10.5014/ajot.2020.032052] [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 The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. OBJECTIVE To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse. DESIGN This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. SETTING Rehabilitation hospital. PARTICIPANTS Forty-one patients with neurological impairments. Outcomes and Measures: The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). RESULTS The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029). CONCLUSIONS AND RELEVANCE The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. What This Article Adds: This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.
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Affiliation(s)
- Paige Lund
- Paige Lund, BSc, MOT, is Occupational Therapist, Family Resource Association, Parksville, British Columbia, Canada
| | - Caitlyn Moir
- Caitlyn Moir, BA, MOT, is Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lisa Kristalovich
- Lisa Kristalovich, BMR (OT), MRSc, is Clinical Faculty, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada, and Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, BScOT, MSc, PhD, is Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Principal Investigator, Rehabilitation Research Program, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada; and Principal Investigator, International Collaboration on Repair Discoveries, VCHRI, Vancouver, British Columbia, Canada;
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Frank CC, Lee L, Molnar F. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e438-e439. [PMID: 30315034 PMCID: PMC6184954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Christopher C Frank
- Médecin de famille et exerce à Kingston (Ontario), sont détenteurs du Certificat de compétence additionnelle en soins aux personnes âgées
| | - Linda Lee
- Médecin de famille et directrice du Centre for Family Medicine Memory Clinic à Kitchener, (Ontario), sont détenteurs du Certificat de compétence additionnelle en soins aux personnes âgées
| | - Frank Molnar
- Spécialiste en médecine gériatrique et exerce à Ottawa (Ontario)
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Frank CC, Lee L, Molnar F. Driving assessment for people with dementia. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:744. [PMID: 30315019 PMCID: PMC6184948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Christopher C Frank
- Family physician practising in Kingston, Ont, hold a Certificate of Added Competence in Care of the Elderly
| | - Linda Lee
- Family physician and Director of the Centre for Family Medicine Memory Clinic in Kitchener, Ont, hold a Certificate of Added Competence in Care of the Elderly
| | - Frank Molnar
- Specialist in geriatric medicine practising in Ottawa, Ont
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Rapoport MJ, Zucchero Sarracini C, Kiss A, Lee L, Byszewski A, Seitz DP, Vrkljan B, Molnar F, Herrmann N, Tang-Wai DF, Frank C, Henry B, Pimlott N, Masellis M, Naglie G. Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial. J Med Internet Res 2018; 20:e194. [PMID: 29802093 PMCID: PMC5993977 DOI: 10.2196/jmir.9126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/10/2018] [Accepted: 03/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)
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Affiliation(s)
- Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Byszewski
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dallas P Seitz
- Seniors Mental Health Program, Providence Care, Kingston, ON, Canada.,Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Frank Molnar
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David F Tang-Wai
- Memory Clinic, University Health Network, Toronto, ON, Canada.,Division of Neurology, Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Frank
- Specialized Geriatric Services, Providence Care, Kingston, ON, Canada.,Division of Geriatric Medicine, Queen's University, Kingston, ON, Canada
| | - Blair Henry
- Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas Pimlott
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Mario Masellis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gary Naglie
- Department of Medicine, Baycrest Health Sciences, Toronto, ON, Canada.,Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
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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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Duncanson H, Hollis AM, O'Connor MG. Errors versus speed on the trail making test: Relevance to driving performance. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:125-130. [PMID: 29407659 DOI: 10.1016/j.aap.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/14/2017] [Accepted: 01/06/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND/OBJECTIVES Many studies have demonstrated that speed to complete items on the Trail Making Tests (TMT A and TMT B) is useful in the prediction of driving safety. However, there is no consensus regarding optimal "cut scores" to discriminate between safe and unsafe drivers. In this study, we examine TMT speed and errors in drivers referred for a road test. DESIGN Retrospective analysis. SETTING Patients referred for a DriveWise® evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts. PARTICIPANTS Drivers age 65 or older were included (total n = 373). Forty-five percent of the sample had been diagnosed with Cognitive Impairment (CI) whereas the remaining participants were in the No Cognitive Impairment (NCI) group. MEASUREMENTS TMT Parts A & B, Folstein Mini Mental Status Examination, Washington University Road Test. RESULTS CI drivers with TMT A speed exceeding 46 s were more likely to fail the road test whereas TMT B speed was not a sensitive metric in this group. In the No Cognitive Impairment (NCI) group, TMT B speed exceeding 131 s predicted driving impairment whereas TMT A speed was not sensitive. Error scores were not useful in the determination of driving fitness for either group. CONCLUSIONS This study provides useful criteria for health providers working with older people in the determination of driving fitness. Results suggest that TMT speed, but not error rate, is associated with road test performance. Based on our work, we advocate that pre-existing dementia should be taken into consideration when using TMT performance as a screen for driving.
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Affiliation(s)
- Haley Duncanson
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States; Harvard Medical School, United States.
| | - Ann M Hollis
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States
| | - Margaret G O'Connor
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States; Harvard Medical School, United States
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Abe T, Raison N, Shinohara N, Shamim Khan M, Ahmed K, Dasgupta P. The Effect of Visual-Spatial Ability on the Learning of Robot-Assisted Surgical Skills. JOURNAL OF SURGICAL EDUCATION 2018; 75:458-464. [PMID: 28918007 DOI: 10.1016/j.jsurg.2017.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/28/2017] [Accepted: 08/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The aim of this study was to determine the correlation of visual-spatial ability with progression along the learning curve for robotic surgical skills training. METHODS A total of 21 novice participants were recruited. All participants completed a training program consisting of 5 training sessions of 30 minutes of virtual reality (VR) simulation and 30 minutes of dry laboratory training. The VR simulation part was the subject of the present study. During VR simulation training, participants performed the basic skill exercises of Camera Targeting 1, Pick and Place, and Peg Board 1 followed by advanced skill exercises of Suture Sponge 1 and Thread the Rings. The visual-spatial ability was assessed using a mental rotation test (MRT). Pearson correlation coefficients were used to assess the relationship between the MRT score and simulator score for the aforementioned 5 tasks. Student t test was used to compare the simulator score between high- and low-MRT score groups. RESULTS A median MRT score of 26/40 (range: 13-38) was observed. Approximately 19 participants completed the full curriculum but 2 did not complete "Thread the Rings" during the study period. A significant correlation was observed between the MRT score and simulator score only in "Suture Sponge 1" over the first 3 attempts (first: r = 0.584, p = 0.0054; second: r = 0.443, p = 0.0443; third: r = 0.4458, p = 0.0428). After the third attempt, this significant correlation was lost. Comparison of the score for "Suture Sponge 1" between the high-MRT and low-MRT scoring participants divided by a median MRT score of 26 also showed a significant difference in the score until the third trial. CONCLUSION Our observations suggest that the spatial cognitive ability influences the initial learning of robotic suturing skills. Further studies are necessary to verify the usefulness of an individual's spatial ability to tailor the surgical training program.
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Affiliation(s)
- Takashige Abe
- Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, United Kingdom; Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Nicholas Raison
- Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, United Kingdom
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M Shamim Khan
- Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, United Kingdom
| | - Kamran Ahmed
- Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, United Kingdom
| | - Prokar Dasgupta
- Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, United Kingdom
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An association of cognitive impairment with diabetes and retinopathy in end stage renal disease patients under peritoneal dialysis. PLoS One 2017; 12:e0183965. [PMID: 28859133 PMCID: PMC5578503 DOI: 10.1371/journal.pone.0183965] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/15/2017] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes and retinopathy have been considered as risk factors of cognitive impairment (CI) in previous studies. We investigated both of these two factors and their relationship with global and specific cognitive functions in end stage renal disease patients under peritoneal dialysis (PD). Methods In this multicenter cross-sectional study, 424 clinically stable patients were enrolled from 5 PD units, who performed PD for at least three months and completed fundoscopy examination if they had diabetes. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), Trail-Making Test forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skills, and language ability. Results PD Patients with DM and Retinopathy had significantly higher prevalence of CI, executive dysfunction, impaired immediate memory and visuospatial skill, compared with patients in non-DM group. By multivariate logistic regression analyses, DM and retinopathy rather than DM only were significantly associated with increased risk for CI, executive dysfunction, impaired immediate memory and visuospatial skill, odds ratios(ORs) and 95% confidence intervals were 2.09[1.11,3.92], 2.89[1.55,5.37], 2.16 [1.15,4.06] and 2.37[1.32,4.22], respectively (all P < 0.05). Conclusions Diabetic PD patients with retinopathy were at two times risk for overall cognitive impairment, executive dysfunction, impaired immediate memory and visuospatial skill as compared to non-diabetic PD patients.
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Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017; 64:328-339. [DOI: 10.1111/1440-1630.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sally M. Fields
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Carolyn A. Unsworth
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Department of Rehabilitation; School of Health Sciences; Jönköping University; Jönköping Sweden
- Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
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Gibbons C, Smith N, Middleton R, Clack J, Weaver B, Dubois S, Bédard M. Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive. Am J Occup Ther 2017; 71:7102260010p1-7102260010p8. [PMID: 28218592 DOI: 10.5014/ajot.2017.019695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. METHOD We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate." RESULTS Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants. CONCLUSION A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.
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Affiliation(s)
- Carrie Gibbons
- Carrie Gibbons, MPH, is Research Coordinator, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Nathan Smith
- Nathan Smith, MPH, is Research Assistant, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Randy Middleton
- Randy Middleton, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - John Clack
- John Clack, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Bruce Weaver
- Bruce Weaver, MSc, is Research Associate, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada, and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Sacha Dubois
- Sacha Dubois, MPH, is Research Statistician, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada; Adjunct Professor, Lakehead University, Thunder Bay, ON, Canada; and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michel Bédard
- Michel Bédard, PhD, is Professor, Lakehead University and Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Director, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada; and Scientific Director, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada;
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Wang Q, Yang ZK, Sun XM, Du Y, Song YF, Ren YP, Dong J. Association of Social Support and Family Environment with Cognitive Function in Peritoneal Dialysis Patients. Perit Dial Int 2017; 37:14-20. [PMID: 28153965 DOI: 10.3747/pdi.2016.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/14/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Cognitive impairment (CI) is a common phenomenon and predictive of high mortality in peritoneal dialysis (PD) patients. This study aimed to analyze the association of social support and family environment with cognitive function in PD patients. ♦ METHODS: This is a cross-sectional study of PD patients from Peking University First Hospital and the Second Affiliated Hospital of Harbin Medical University. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), executive function was measured by the A and B trail-making tests, and other cognitive functions were measured by the Repeatable Battery for the Assessment of Neuropsychological Status. Social support was measured with the Social Support Scale developed by Xiaoshuiyuan and family environment was measured with the Chinese Version of the Family Environment Scale (FES-CV). ♦ RESULTS: The prevalence of CI and executive dysfunction among the 173 patients in the study was, respectively, 16.8% and 26.3%. Logistic regression found that higher global social support (odds ratio [OR] = 1.09, 1.01 - 1.17, p = 0.027) and subjective social support predicted higher prevalence of CI (OR = 1.13, 1.02 - 1.25, p = 0.022), adjusting for covariates. Analyses of the FES-CV dimensions found that greater independence was significantly associated with better immediate memory and delayed memory. Moreover, higher scores on achievement orientation were significantly associated with poorer language skills. ♦ CONCLUSIONS: Our findings indicate that social support is negatively associated with the cognitive function of PD patients and that some dimensions of the family environment are significantly associated with several domains of cognitive function.
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Affiliation(s)
- Qin Wang
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Zhi-Kai Yang
- Department of Nephrology, Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
| | - Xiu-Mei Sun
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yun Du
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yi-Fan Song
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Ye-Ping Ren
- Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Department of Nephrology, Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China
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Kim YJ, An H, Kim B, Park YS, Kim KW. An International Comparative Study on Driving Regulations on People with Dementia. J Alzheimers Dis 2017; 56:1007-1014. [DOI: 10.3233/jad-160762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- You Joung Kim
- National Institute of Dementia, Seongnam, South Korea
| | - Hoyoung An
- National Institute of Dementia, Seongnam, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Binna Kim
- National Institute of Dementia, Seongnam, South Korea
| | - Young Shin Park
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
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Lee L, Molnar F. Driving and dementia: Efficient approach to driving safety concerns in family practice. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:27-31. [PMID: 28115437 PMCID: PMC5257216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To provide primary care physicians with an approach to driving safety concerns when older persons present with memory difficulties. SOURCES OF INFORMATION The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. MAIN MESSAGE One of the most challenging aspects of dementia care is the assessment of driving safety. Drivers with dementia are at higher risk of motor vehicle collisions, yet many drivers with mild dementia might be safely able to continue driving for several years. Because safe driving is dependent on multiple cognitive and functional skills, clinicians should carefully consider many factors when determining if cognitive concerns affect driving safety. Specific findings on corroborated history and office-based cognitive testing might aid in the physician's decisions to refer for comprehensive on-road driving evaluation and whether to notify transportation authorities in accordance with provincial reporting requirements. Sensitive communication and a person-centred approach are essential. CONCLUSION Primary care physicians must consider many factors when determining if cognitive concerns might affect driving safety in older drivers.
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Affiliation(s)
- Linda Lee
- Family physician at the Center for Family Medicine Family Health Team in Kitchener, Ont, Schlegel Research Chair in Primary Care for Elders at the Schlegel-UW Research Institute for Aging, and Associate Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
| | - Frank Molnar
- Geriatrician in Ottawa, Ont, Medical Director of the Regional Geriatric Program of Eastern Ontario, and Associate Professor in the Department of Medicine at the University of Ottawa
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Lee L, Molnar F. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e9-e14. [PMID: 28115452 PMCID: PMC5257231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objectif Fournir aux médecins de première ligne une approche relative aux préoccupations de sécurité au volant lorsque les personnes âgées présentent des troubles de mémoire. Sources d’information L’approche est fondée sur un programme de formation agréé des cliniques de la mémoire, élaboré par la clinique de la mémoire du Centre for Family Medicine. Message principal L’un des aspects les plus difficiles des soins aux personnes atteintes de démence est l’évaluation de la sécurité au volant. Les conducteurs atteints de démence présentent un risque plus élevé de collisions, quoique de nombreux conducteurs dont l’atteinte est légère soient aptes à conduire pendant encore plusieurs années. Puisque l’aptitude à conduire dépend de multiples compétences cognitives et fonctionnelles, de nombreux facteurs entrent en jeu lorsque les cliniciens déterminent si les sujets de préoccupation en matière de cognition se répercutent sur l’aptitude à conduire. Les observations spécifiques tirées de l’anamnèse corroborée et des tests cognitifs effectués en cabinet pourraient aider le médecin à décider s’il doit recommander le patient à un examen pratique complet et aviser les autorités provinciales du transport, conformément aux exigences en matière de déclarations. La communication doit être axée sur le patient et menée avec tact. Conclusion Les médecins de première ligne doivent tenir compte de plusieurs facteurs lorsqu’ils déterminent si les sujets de leurs préoccupations en matière de cognition pourraient se répercuter sur l’aptitude des conducteurs âgés à prendre le volant.
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Affiliation(s)
- Linda Lee
- Médecin de famille de l'équipe de santé familiale au Center for Family Medicine à Kitchener, en Ontario, titulaire de la chaire de recherche Schlegel en soins primaires chez les aînés au Schlegel-UW Research Institute for Aging et professeure clinique agrégée à la Faculté de médecine familiale de l'Université McMaster à Hamilton, en Ontario.
| | - Frank Molnar
- Gériatre à Ottawa, en Ontario, directeur médical du Programme gériatrique régional de l'Est de l'Ontario et professeur agrégé à la Faculté de médecine de l'Université d'Ottawa
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Performance of the Modified Mini-Mental State Examination (3MS) in Assessing Specific Cognitive Function in Patients Undergoing Peritoneal Dialysis. PLoS One 2016; 11:e0166470. [PMID: 27911914 PMCID: PMC5135044 DOI: 10.1371/journal.pone.0166470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/28/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE While Cognitive impairment (CI) has been identified as an independent risk factors for mortality in patients undergoing peritoneal dialysis (PD), it is inadequately assessed. We evaluated the applicability of the Modified Mini-Mental State Examination (3MS) in assessing specific cognitive function and compared it to a detailed neuropsychological test battery as the reference standard. METHODS In this multicentric cross-sectional study, we enrolled 445 clinically stable patients from five PD units, who were undergoing PD for at least 3 months. The 3MS was evaluated for general cognitive function. A detailed neuropsychological battery including domains of immediate memory, delayed memory, executive function, language, and visuospatial ability were evaluated as reference standards. Sensitivity and specificity of the 3MS was determined by using receiver operating characteristic (ROC) analysis. RESULTS The CI prevalence evaluated by 3MS was 23.6%. PD patients with CI performed worse in all cognitive domains. The 3MS correlated well with specific cognitive domains. However, 18.5%, 57.4%, 12.6%, 8.8%, and 41.2% of patients whom were idendified as normal by 3MS still showed executive dysfunction, immediate memory impairment, delayed memory impairment, and language-ability and visuospatial-ability impairment, respectively. The 3MS identified patients having specific cognitive dysfunction with varied extent of diagnostic value, with 0.50, 0.42, 0.35, 0.34, and 0.26 of Youden index in executive function, delayed memory, language ability, immediate memory, and visuospatial ability, respectively. CONCLUSIONS The 3MS is not a comprehensive instrument for major cognitive domains in PD patients. It could, however, be used for executive dysfunction and delayed memory impairment screening.
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Classen S, Alvarez L. Caregivers' Impressions Predicting Fitness to Drive in Persons With Parkinson's. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016; 36:5-13. [PMID: 27504688 DOI: 10.1177/1539449215601117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease, increasing in incidence, with a known impact on fitness to drive. Although great progress has been made on evidence-based guidelines for assessing fitness to drive of persons with PD, a need remains for early identification of at-risk drivers in need of comprehensive assessment. This study investigated whether caregivers of drivers with PD could predict the driver's on-road outcome. We also investigated whether the predictive value of their impressions differed from that of drivers themselves, their neurologist, or from information provided by standardized measures of visual and divided attention. Caregivers' risk impressions (odds ratio [OR] = 13.76, p = .03) and Trail Making Test Part B (Trails B; OR = 0.41, p = .02) emerged as significant predictors of passing an on-road assessment. Our findings suggest that caregiver impressions, with a measure of set shifting, may be used as an efficient screen to identify drivers with PD who are potentially at risk for failing an on-road assessment.
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Evidence Based Review of Fitness-to-Drive and Return-to-Driving Following Traumatic Brain Injury. Geriatrics (Basel) 2016; 1:geriatrics1030017. [PMID: 31022811 PMCID: PMC6371138 DOI: 10.3390/geriatrics1030017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published before June 2016 using MeSH search terms. Using the American Academy of Neurology’s classification criteria, 24 articles were included after reviewing 1998 articles. Studies were rated by class (I–IV), with I being the highest level of evidence. Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator and surveys). There were no Class I studies. Based on Class II studies, only Post-traumatic amnesia (PTA) duration was found to be probably predictive of on-road driving performance. There is limited evidence concerning predictors of return to driving. The findings suggest further evidence is needed to identify predictors of on-road driving performance in persons with TBI. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines.
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Yamin S, Stinchcombe A, Gagnon S. Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2016; 31:351-60. [PMID: 26655744 PMCID: PMC10852565 DOI: 10.1177/1533317515618898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study sought to predict driving performance of drivers with Alzheimer's disease (AD) using measures of attention, visual processing, and global cognition. Simulated driving performance of individuals with mild AD (n = 20) was contrasted with performance of a group of healthy controls (n = 21). Performance on measures of global cognitive function and specific tests of attention and visual processing were examined in relation to simulated driving performance. Strong associations were observed between measures of attention, notably the Test of Everyday Attention (sustained attention; r = -.651, P = .002) and the Useful Field of View (r = .563, P = .010), and driving performance among drivers with mild AD. The Visual Object and Space Perception Test-object was significantly correlated with the occurrence of crashes (r = .652, P = .002). Tests of global cognition did not correlate with simulated driving outcomes. The results suggest that professionals exercise caution when extrapolating driving performance based on global cognitive indicators.
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Affiliation(s)
- Stephanie Yamin
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada Faculty of Human Sciences, Saint Paul University, Ottawa, Ontario, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Cognitive Performance, Driving Behavior, and Attitudes over Time in Older Adults. Can J Aging 2016; 35 Suppl 1:81-91. [DOI: 10.1017/s071498081600009x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉNous avons théorisé que les changements au fil du temps dans les performances cognitives sont associés à des changements dans les perceptions, les attitudes et les comportements d’auto-régulation des personnes âgées qui conduisent. Les adultes âgés en bonne santé (n = 928) ont subi les évaluations cognitives au début avec deux suivis annuels subséquents, et ils ont rempli des formulaires avec des échelles qui mesurent leurs perceptions, les attitudes et les comportements de conduite. L’analyse multivariée montre des petites relations, mais statistiquement significatives, entre les tests cognitifs et les mesures qui ont été auto-déclarée, les plus grandes amplitudes entre les scores étant sur les sentiers B tâche cognitive (secondes), la perception de la capacité de conduire (β = 0,32), et l’évasion des situations de conduite (β = 0,55) (p <0,05). Selon cette analyse exploratoire, le ralentissement cognitif et le dysfonctionnement exécutif semblent être associés aux capacités à conduire perçues d'être modestement inférieurs et à l’évitement accru des situations de conduite au fil du temps.
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Dong J, Pi HC, Xiong ZY, Liao JL, Hao L, Liu GL, Ren YP, Wang Q, Duan LP, Zheng ZX. Depression and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Cross-sectional Study. Am J Kidney Dis 2016; 67:111-8. [DOI: 10.1053/j.ajkd.2015.06.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/23/2015] [Indexed: 11/11/2022]
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Papandonatos GD, Ott BR, Davis JD, Barco PP, Carr DB. Clinical Utility of the Trail-Making Test as a Predictor of Driving Performance in Older Adults. J Am Geriatr Soc 2015; 63:2358-64. [PMID: 26503623 DOI: 10.1111/jgs.13776] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the clinical utility of the Trail-Making Tests (TMTs) as screens for impaired road-test performance. DESIGN Secondary analyses of three data sets from previously published studies of impaired driving in older adults using comparable road test designs and outcome measures. SETTING Two academic driving specialty clinics. PARTICIPANTS Older drivers (N = 392; 303 with cognitive impairment, 89 controls) from Rhode Island and Missouri. MEASUREMENTS Standard operating characteristics were evaluated for the TMT Part A (TMT-A) and Part B (TMT-B), as well as optimal upper and lower test cut-points that could be useful in defining groups of drivers with indeterminate likelihood of impaired driving who would most benefit from further screening or on-road testing. RESULTS Discrimination remained high (>70%) when cut-points for the TMTs derived from Rhode Island data were applied to Missouri data, but calibration was poor (all P < .01). TMT-A provided the best utility for determining a range of scores (68-90 seconds) for which additional road testing would be indicated in general practice settings. A high frequency of cognitively impaired participants unable to perform the TMT-B test within the allotted time limited the utility of the test (>25%). Mere inability to complete the test in a reasonable time frame (e.g., TMT-A > 48 seconds or TMT-B > 108 seconds) may still be a useful tool in separating unsafe from safe or marginal drivers in such samples. CONCLUSION The TMTs (particularly TMT-A) may be useful as screens for driving impairment in older drivers in general practice settings, where most people are still safe drivers, but more-precise screening measures need to be analyzed critically in a variety of clinical settings for testing cognitively impaired older drivers.
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Affiliation(s)
| | - Brian R Ott
- Department of Neurology, Warren Alpert Medical School, Brown University, and Rhode Island Hospital, Providence, Rhode Island
| | - Jennifer D Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, and Rhode Island Hospital, Providence, Rhode Island
| | - Peggy P Barco
- Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, Missouri
| | - David B Carr
- Department of Medicine and Neurology, School of Medicine, Washington University, St. Louis, Missouri
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Vaucher P, Herzig D, Cardoso I, Herzog MH, Mangin P, Favrat B. The trail making test as a screening instrument for driving performance in older drivers; a translational research. BMC Geriatr 2014; 14:123. [PMID: 25420615 PMCID: PMC4256796 DOI: 10.1186/1471-2318-14-123] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many countries, primary care physicians determine whether or not older drivers are fit to drive. Little, however, is known regarding the effects of cognitive decline on driving performance and the means to detect it. This study explores to what extent the trail making test (TMT) can provide indications to clinicians about their older patients' on-road driving performance in the context of cognitive decline. METHODS This translational study was nested within a cohort study and an exploratory psychophysics study. The target population of interest was constituted of older drivers in the absence of important cognitive or physical disorders. We therefore recruited and tested 404 home-dwelling drivers, aged 70 years or more and in possession of valid drivers' licenses, who volunteered to participate in a driving refresher course. Forty-five drivers also agreed to undergo further testing at our lab. On-road driving performance was evaluated by instructors during a 45 minute validated open-road circuit. Drivers were classified as either being excellent, good, moderate, or poor depending on their score on a standardized evaluation of on-road driving performance. RESULTS The area under the receiver operator curve for detecting poorly performing drivers was 0.668 (CI95% 0.558 to 0.778) for the TMT-A, and 0.662 (CI95% 0.542 to 0.783) for the TMT-B. TMT was related to contrast sensitivity, motion direction, orientation discrimination, working memory, verbal fluency, and literacy. Older patients with a TMT-A ≥ 54 seconds or a TMT-B ≥ 150 seconds have a threefold (CI95% 1.3 to 7.0) increased risk of performing poorly during the on-road evaluation. TMT had a sensitivity of 63.6%, a specificity of 64.9%, a positive predictive value of 9.5%, and a negative predictive value of 96.9%. CONCLUSION In screening settings, the TMT would have clinicians uselessly consider driving cessation in nine drivers out of ten. Given the important negative impact this could have on older drivers, this study confirms the TMT not to be specific enough for clinicians to justify driving cessation without complementary investigations on driving behaviors.
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Affiliation(s)
- Paul Vaucher
- Traffic Medicine and Psychology Unit, University Center of Legal Medicine, Lausanne-Geneva, University Hospital of Lausanne, Rue Saint-Martin 26, 1005 Lausanne, Switzerland.
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