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: 8.29). 11/2012; 79(20):2067-2074. DOI: 10.1212/WNL.0b013e3182749e95
Source: PubMed


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, Sep 30, 2015
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    • "chomotor speed component (Sanchez-Cubillo et al, 2009). While there is insufficient evidence to support a single valid screening test for older drivers (Be´dard et al, 2008), multiple studies suggest that the TMT-B may be reasonably predictive of driving outcomes among drivers with PD (Crizzle et al, 2012). The TMT-B is also a routine component in the assessment of fitness to drive in professional guidelines issued by licensing bodies and medical associations in Canada (Canadian Council of Motor Transport Administrators, 2013; Canadian Medical Association , 2012) and the United States (National Highway Traffic Safety Administration, 2010). "
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    ABSTRACT: To determine the extent and nature of driving self-regulation in drivers with Parkinson disease (PD) and factors associated with self-regulatory practices. Although people with PD have consistently been shown to have driving impairments, few studies have examined self-regulatory driving practices and their relationship to driving performance. We used a self-report driving questionnaire to examine driving self-regulation in 37 drivers with PD and 37 healthy age-matched controls. We also analyzed factors associated with self-regulatory practices, primarily demographic, disease-related, psychological, and simulated driving performance variables. The drivers with PD reported significantly higher rates of self-perceived decline in their driving ability (P=0.008) and driving significantly shorter distances per week (P=0.004) than controls. Unfamiliar situations (P=0.009), in-car distractions (P<0.001), low visibility conditions (P=0.004), and long journeys (P=0.003) were particularly challenging for the drivers with PD, and their pattern of driving avoidance mirrored these difficulties. The use of self-regulatory strategies among drivers with PD was associated with female sex (rho=0.42, P=0.009) and perceived decline in driving ability (rho=-0.55, P<0.001), but not with age or objective measures of disease severity, cognition, or simulated driving performance. Drivers with PD reported driving less overall and restricting their driving to avoid particularly difficult circumstances. Further research is warranted on effective use of self-regulation strategies to improve driving performance in people with PD.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2015; 28(2):80-91. DOI:10.1097/WNN.0000000000000058 · 0.95 Impact Factor
    • "About mild cognitive impairment: Devlin et al. 2012; Frittelli et al. 2009; Olsen et al. 2014; Wadley et al. 2009 Alzheimer's disease: visual variant Caselli 2000; Chan et al., 2015; Levine et al., 1993; Snyder 2005 Alzheimer's disease: language variant None, but about aphasia in general: Rau and Golper 1977; Rizzo 2004; Snyder 2005 Vascular & Mixed dementia Fitten et al. 1995; Gilley et al. 1991; Seiler et al. 2012 Frontotemporal dementia: behavioural variant Ernst et al. 2010; Miller et al. 1997; Seiler et al. 2012; De Simone et al. 2007; Snyder 2005; Turk and Dugan 2014 Frontotemporal dementia: progressive non-fluent aphasia None, but about aphasia in general: Rau and Golper 1977; Rizzo 2004; Snyder 2005 Frontotemporal dementia: semantic dementia Ernst et al. 2010; Luzzi et al. 2014 Dementia with Lewy Bodies Seiler et al. 2012; Snyder 2005 Parkinson's disease dementia None, but about Parkinson's disease in general: Classen et al. 2014; Crizzle et al. 2012; Devos et al. 2007; Singh et al. 2007; Snyder 2005; Uc et al. 2009 Progressive supranuclear palsy: "
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    ABSTRACT: Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various aetiologies and the question is whether dementias of different aetiology have similar effects on driving ability. The literature on the effects of dementia of various aetiologies on driving ability is reviewed. Studies addressing dementia aetiologies and driving were identified through PubMed, PsychINFO and Google Scholar. Early symptoms and prognoses differ between dementias of different aetiology. Therefore, different aetiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia aetiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all aetiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route while patients with frontotemporal dementia are more inclined to make tactical level errors because of impaired hazard perception. Patients with other dementia aetiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various aetiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behaviour can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g. compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia aetiologies are taken into consideration.
    Traffic Injury Prevention 04/2015; DOI:10.1080/15389588.2015.1038786 · 1.41 Impact Factor
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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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