We previously developed a short clinical battery, consisting of contrast sensitivity, Clinical Dementia Rating, the Unified Parkinson's Disease Rating Scale-motor section (UPDRS III), and disease duration, which correctly classified 90% of drivers with Parkinson's Disease (PD). The aim of this study was to validate that screening battery in a different sample of PD drivers.
Sixty drivers with PD were enrolled to validate our original screening battery to predict driving fitness decisions (pass-fail) by a state agency where drivers underwent detailed visual, cognitive, and on-road testing.
Twenty-four participants (40%) failed the driving evaluation. The screening battery correctly classified 46 (77%) participants (sensitivity and negative predictive value = 96%; specificity and positive predictive value = 64%). Adding other clinical predictors (e.g., age of onset, Hoehn-Yahr stage instead of UPDRS III) failed to improve the specificity of the model when the sensitivity was kept constant at 96%. However, a driving simulator evaluation improved the specificity of the model to 94%.
The original clinical battery proved to be a valid screening tool that accurately identifies fit drivers with PD and select those who need more detailed testing at specialized centers.
"Em condutores com doença de Parkinson, outra doença neurodegenerativa frequente na população idosa, o UFOV Test, o Trail Making Test A & B (Cavaco et al., 2013) e a cópia da Figura Complexa de Rey (Bonifácio, Cardoso-Pereira, & Pires, 2003; Espírito-Santo et al., 2015) constituem preditores significativos do desempenho de condução real (Klimkeit, Bradshaw, Charlton, Stolwyk, & Georgiou-Karistianis, 2009). A CDR, em conjunto com o exame motor da Unified Parkinson's Disease Rating Scale, evidencia também um valor incremental na avaliação clínica de condutores com doença de Parkinson (Devos et al., 2013). "
[Show abstract][Hide abstract] ABSTRACT: This study examined whether symptoms (motor, cognitive, vision, sleepiness, depression) of Parkinson's disease (PD) were associated with restricted driving practices. To quantify driving practices, electronic devices were installed in the vehicles of 27 drivers with PD (78 % men; M = 71.6, SD = 6.6; Unified Parkinson's Disease Rating Scale (UPDRS) motor score M = 30.1, SD = 8.6; disease duration M = 3.9, SD = 2.8 years) and 20 controls (80 % men; M = 70.6, SD = 7.9) for 2 weeks. Participants completed measures of sleepiness, depression, quality of life, and assessments of motor, cognitive and visual functions. The PD group had significantly slower brake response times (p < 0.05), poorer cognitive and quality of life scores (p < 0.01) and greater depression (p < 0.05) compared to controls. Slower reaction time was significantly related to reduced driving; specifically, fewer trips (r = -0.46; p < 0.05), distance (r = -0.54, p < 0.01) and duration at night (r = -0.58, p < 0.01). Better cognitive scores were associated with driving less often in difficult situations such as bad weather and rush hour (p < 0.05), as well as reduced speed on city streets, but only for the control group. While most drivers with PD rated their overall health as good or excellent, the five PD drivers who rated their health more poorly had significantly worse clinical symptoms (UPDRS motor scores, contrast sensitivity, depression, brake response time) and more restricted driving patterns. These findings show that drivers with PD who perceive their health poorly have greater symptomatology and were more likely to restrict their driving, possibly due to noticeable declines in multiple driving-related abilities.
Journal of Neurology 07/2013; 260(10). DOI:10.1007/s00415-013-7017-9 · 3.38 Impact Factor
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