Article

Parkinson disease and driving An evidence-based review

From the Departments of Aging and Geriatric Research (A.M.C.) and Occupational Therapy (A.M.C., S.C.)
Neurology (Impact Factor: 8.3). 11/2012; 79(20):2067-2074. DOI: 10.1212/WNL.0b013e3182749e95
Source: PubMed

ABSTRACT The growing literature on driving in Parkinson disease (PD) has shown that driving is impaired in PD compared to healthy comparison drivers. PD is a complex neurodegenerative disorder leading to motor, cognitive, and visual impairments, all of which can affect fitness to drive. In this review, we examined studies of driving performance (on-road tests and simulators) in PD for outcome measures and their predictors. We searched through various databases and found 25 (of 99) primary studies, all published in English. Using the American Academy of Neurology criteria, a study class of evidence was assigned (I-IV, I indicating the highest level of evidence) and recommendations were made (Level A: predictive or not; B: probably predictive or not; C: possibly predictive or not; U: no recommendations). From available Class II and III studies, we identified various cognitive, visual, and motor measures that met different levels of evidence (usually Level B or C) with respect to predicting on-road and simulated driving performance. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with PD are needed by policy makers and clinicians to develop evidence-based guidelines.

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Available from: Alexander M Crizzle, Aug 11, 2015
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    • "In addition, we were unable to collect information on why falls occurred (i.e., due to freezing of gait), when these occurred (i.e., at night), or whether they occurred in the " on " of " off " medication state. Falls are more likely to occur during the wearing off phase (Albanese, 2007), and there is some evidence that the UPDRS motor scores in the " off " (versus the " on " ) state are a stronger predictor of driving performance (Crizzle et al. 2012b). For the PD sample as a whole, lower balance confidence (ABC) scores were significantly related to poorer contrast sensitivity, greater LED levels, and self-reported avoidance of driving in challenging situations. "
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    ABSTRACT: Aims: Factors related to fall risk (balance confidence, motor, visual, and cognitive deficits) may also affect the driving practices of people with Parkinson's disease (PD). The purpose of this study was to explore these potential associations. Methods: A sample of 11 self-reported fallers (mean age 72.3 ± 6.0 years; 55% men) and 16 non-fallers (mean age 71.1 ± 7.2 years; 100% men) were assessed on a battery of clinical measures and brake reaction and response time. Electronic devices were installed in vehicles to examine naturalistic driving practices. Results: In the sample overall, lower balance confidence scores were associated with worse contrast sensitivity, higher levodopa equivalency dosage, and more reported driving avoidance. Fallers had significantly lower balance confidence (p < 0.01), more episodes of hard braking (p < 0.05), and drove at slower speeds (km/hour) on most roadways (p < 0.05). Conclusions: Researchers and clinicians should consider mobility problems, particularly recurrent falls and balance confidence, which may influence driving practices.
    Physical & Occupational Therapy in Geriatrics 12/2014; 33(1). DOI:10.3109/02703181.2014.991057
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    • "This was an unexpected result given that cognitive dysfunction has been implicated as contributing to impaired driving ability in PD patients. Prior research has demonstrated that certain cognitive tests such as the ReyeOsterrieth Complex Figure Test (ROCF), Trails B, Trails B-A, and functional reach may be predictive of impaired driving performance in PD [1]. Although we did not have these specific detailed cognitive tests to analyze in our cohort, our study found no significant difference in MOCA scores, nor a significant difference in proportion of drivers with MoCA scores in the MCI range between the safe and risky groups, supporting our observation that neocortical cholinergic uptake is not associated with risky driving behavior. "
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    Parkinsonism & Related Disorders 09/2013; 20(1). DOI:10.1016/j.parkreldis.2013.08.021 · 4.13 Impact Factor
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    • "However, due to the categorical nature of the scale, findings are difficult to interpret, particularly as our cohort only ranged from state 2 to 3 although subjects with MHY scores of ≥2.5 were likely to fail the road test than those categorized as stage 2. Although the UPDRS is considered the gold standard of PD assessment for movement disorder specialists/neurologists, the application in isolation to predict pass/fail on-road outcomes performs poorly, consistent with findings of a recent evidence based review [26]. Visual-cognitive deficits (e.g., visuoperceptual , spatial, attentional, information processing speed) are critical to driving impairment [6, 8, 27–31] "
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    01/2013; 3(2):153-60. DOI:10.3233/JPD-120152
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