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.


Available from: Alexander M Crizzle
    • "Yet, they have enabled a better understanding of driving errors and their relationships with the type and degree of a driver's functional impairments, allowing researchers to distinguish between controls and people with PD (Uc and Rizzo, 2011). Simulator studies have shown that drivers with PD exhibit substantial difficulties while driving under low visibility conditions, which is likely the result of deficits in contrast sensitivity (Uc et al., 2009, Crizzle et al. 2012). In a validation study (Devos et al. 2013a; Devos et al. 2007) of a screening battery to predict fitness to drive decisions in individuals with PD, the inclusion of driving simulation increased the accuracy of the clinical model, suggesting an association between driving simulation measures and real-world driving performance in PD. Lee et al. (2007) explored the validity of an interactive PC-based STISIM driving simulator against on-road driving in 50 PD patients and 150 healthy controls of comparable age (aged "
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    ABSTRACT: Objective: The aim of this studywas to explore whether varying levels of operational and tactical driving task demand differentially affect drivers with Parkinson's disease (PD) and control drivers in their sign recall. Methods: Study participants aged between 50 and 70 years included a group of drivers with PD (n = 10) and a group ofage- and sex-matched control drivers(n = 10). Their performance in a sign recall task was measured using a driving simulator. Results: Drivers of the control group performed better than drivers with PD in a sign recall task, but this trend was not statistically significant (p = 0.43).Also, regardless of group membership, subjects' performance differed according to varying levels of task demand. Performance in the sign recall task was more likely to drop with increasing task demand (p = 0.03).This difference was significant when the variation in task demand was associated with a cognitive task, i.e., when drivers were required to apply the instructions from working memory. Conclusions: Although the conclusions drawn from this study are tentative, the evidence presented here is encouraging with regard to the use of a driving simulator to examine isolated cognitive functions underlying driving performance in PD. With an understanding of its limitations, such driving simulation in combination with functional assessment batteries measuring physical, visual and cognitive abilities could comprise one component of a multi-tiered system to evaluate medical fitness to drive.
    Traffic Injury Prevention 09/2015; DOI:10.1080/15389588.2015.1091926 · 1.41 Impact Factor
    • "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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