Mark J Rapoport

Mark J Rapoport
Sunnybrook Health Sciences Centre | sunnybrook · Department of Psychiatry

MD, FRCPC

About

165
Publications
12,818
Reads
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3,403
Citations
Additional affiliations
July 2002 - present
Sunnybrook Health Sciences Centre
Position
  • Staff Psychiatrist
July 2002 - present
University of Toronto
Position
  • Professor (Associate)

Publications

Publications (165)
Article
Background and Objectives The prospect of automated vehicles (AV) has generated excitement among the public and the research community about their potential to sustain the safe driving of people with dementia. However, no study to date has assessed the views of people with dementia on whether AVs may address their driving challenges. Research Desi...
Article
Full-text available
We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77–96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendlines...
Article
Full-text available
Background: Increasing evidence implicates oxidative stress (OS) in Alzheimer disease (AD) and mild cognitive impairment (MCI). Depletion of the brain antioxidant glutathione (GSH) may be important in OS-mediated neurodegeneration, though studies of post-mortem brain GSH changes in AD have been inconclusive. Recent in vivo measurements of the brai...
Article
Full-text available
Background Transcranial direct current stimulation (tDCS) is a non-invasive type of brain stimulation that uses electrical currents to modulate neuronal activity. A small number of studies have investigated the effects of tDCS on cognition in patients with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), and have demonstrated variable...
Article
Objectives To establish the crash risk for drivers with epilepsy and quantify any impacts on on-road driving performance. Methods A systematic search of public health-, psychology-, and transport-databases was conducted. This systematic review was registered with PROSPERO (see CRD42019129664). The quality of evidence for each study was rated using...
Poster
People with dementia (PwD) often become lost, which is commonly attributed to spatial disorientation, one of the earliest symptoms of dementia, particularly of the Alzheimer’s disease type. Spatial disorientation can limit a person's ability to navigate in an outdoor environment. As a result, PwD experience outdoor mobility decline, which, in turn,...
Article
Full-text available
Background and objectives: Driving cessation is a complex challenge with significant emotional and health implications for people with dementia, which also affects their family care partners. Automated vehicles (AVs) could potentially be used to delay driving cessation and its adverse consequences for people with dementia and their care partners....
Poster
Background: The decision to stop driving and the transition to non-driving is emotional and challenging not only for people with dementia (PWD) and their family members, but also for healthcare providers (HCPs) of multiple disciplines. With the growing number of older drivers, including drivers with dementia, HCPs are being increasingly tasked wit...
Article
Full-text available
Background and objectives: While a range of psychotherapeutic interventions is available to support individuals with dementia, comprehensive reviews of interventions are limited, particularly with regard to outcomes related to adjustment and acceptance. The current review assesses studies that evaluated the impact of various forms of psychotherape...
Article
Background Older adults constitute the group most vulnerable to COVID-19 mortality. As a result, in North America and elsewhere, older adults have been strongly advised to shelter in place. Older adults also represent the fastest growing segment of licensed drivers. Objective We examined the change in injuries and fatalities sustained by younger a...
Article
Full-text available
Introduction: An active lifestyle may protect older adults from cognitive decline. Yet, due to the complex nature of outdoor environments, many people living with dementia experience decreased access to outdoor activities. In this context, conceptualizing and measuring outdoor mobility is of great significance. Using the global positioning system...
Preprint
Full-text available
Background: Increasing evidence implicates oxidative stress (OS) in Alzheimer Disease (AD) and Mild Cognitive Impairment (MCI). Depletion of the brain antioxidant glutathione (GSH) may be important in OS-mediated neurodegeneration, though studies of post-mortem brain GSH changes in AD have been inconclusive. Recent in vivo measurements of brain and...
Article
Introduction Maintaining an active lifestyle and participating in social activities are key components of healthy ageing. These components rely on the individuals’ ability to remain mobile out of home. The global positioning system (GPS) is increasingly used to assess outdoor mobility of older adults. However, there is a gap in establishing a frame...
Poster
Introduction Driving often provides a sense of independence, quality of life and emotional wellbeing. For older adults living with dementia, driving cessation eventually becomes inevitable. Driving cessation has been shown to negatively impact older adults’ mobility and, consequently, quality of life. Caregivers of persons with dementia (PWD) who h...
Article
Introduction Driving is a primary means of mobility. Driving cessation is associated with poor mental health outcomes, including increased risk of depression. We investigated the relationship between driving status and depression symptoms in a large Canadian sample of mid-aged and older adults. We examined whether social support buffers the relatio...
Poster
Full-text available
Driving often provides a sense of independence, quality of life and emotional wellbeing. For older adults living with dementia, driving cessation eventually becomes inevitable. Driving cessation has been shown to negatively impact older adults’ mobility and, consequently, quality of life. Caregivers of persons with dementia (PWD) who have ceased dr...
Article
Neuropsychiatric symptoms (NPS) are common features of Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), and are associated with poorer cognition. Transcranial direct current stimulation (tDCS), a non‐invasive type of brain stimulation, has been investigated for the treatment of some NPS in a few small AD studies, but with negative resu...
Presentation
Maintaining an active lifestyle and participating in social activities are key components of healthy ageing. These components rely on the individuals’ ability to remain mobile out of home. The global positioning system (GPS) is increasingly used to assess outdoor mobility of older adults. However, there is a gap in establishing a framework that rec...
Article
Full-text available
Background Outdoor mobility is an important aspect of older adults’ functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and c...
Chapter
Although there are particularly salient and problematic challenges in addressing the transportation needs of people living in rural areas with dementia, there has been limited research in this area. In this chapter, we discuss the risks of driving with dementia, including the risks of collisions but also the adverse outcomes associated with cessati...
Article
Background and objectives: Despite the well-recognized difficulty that persons with dementia and family carers experience in the decision making and transition to nondriving, there are few interventions and resources to support them. As part of our ongoing research to develop a driving cessation toolkit that addresses this gap, we sought to examin...
Article
BACKGROUND Drivers at risk of sudden incapacitation from syncope pose a potential threat to themselves and to society. The purpose of this systematic review is to synthesize the risk of motor vehicle collisions (MVC) for patients with a history of syncope. METHODS We systematically searched MEDLINE (1946 – 2019) as well as CINAHL, Embase, Psychinf...
Preprint
BACKGROUND Outdoor mobility is an important aspect of older adults’ functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and c...
Article
Full-text available
The Canadian Longitudinal Study on Aging (CLSA) is a longitudinal health study that will follow individuals aged 45 to 85 for 20 years. At baseline, participants completed measures related to driving status and mental health outcomes (e.g., Center for Epidemiologic Studies Depression Scale; CES-D). In this study we examined the associations between...
Article
Full-text available
The World Health Organization (WHO) emphasized the importance of age-friendly communities in supporting quality of life for older adults. We aimed to determine the contribution of the age-friendliness of communities to quality of life in a sample of healthy older adults. We used data collected through a longitudinal study on drivers and ex-drivers....
Article
Clinicians face challenges in deciding which older patients with dementia to report to transportation administrators. This study used a qualitative thematic analysis to understand the utility and limitations of implementing a computer-based Driving in Dementia Decision Tool in clinical practice. Thirteen physicians and eight nurse practitioners par...
Poster
Introduction Decision-making about driving cessation and transitioning to non-driving is a challenging and complex issue faced by drivers diagnosed with dementia and their families. Driving cessation is associated with adverse psychosocial and health-related impacts for persons with dementia including a reduction in quality of life. To address the...
Article
The current study aimed to: 1. to confirm the 21-item, three-factor Driver Behaviour Questionnaire (DBQ) structure suggested by Koppel et al. (2018) within an independent sample of Canadian older drivers; 2. to examine whether the structure of the DBQ remained stable over a four-year period; 3. to conduct a latent growth analysis to determine wheth...
Article
Background: Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population. Objectives: The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are a...
Article
Background Major life transitions can negatively impact the emotional well-being of older people. This study examined the effectiveness of interventions that target the three most common transitions in later life, namely bereavement, retirement, and relocation. Methods A systematic search was performed via MEDLINE, EMBASE, CINAHL, Cochrane Library...
Article
Objective: To synthesize knowledge of the risk of motor vehicle collision (MVC) following a traumatic brain injury (TBI) and the associated risk of driving impairment, as measured by on-road tests, computerized simulators, and self-reported or state-recorded driving records. Methods: Our international team searched 7 databases for studies publis...
Article
Objectives: To review qualitative research on the specific challenges and strategies that relate to driving cessation for older adults with dementia, from the perspectives of key informant groups. Method: A meta-synthesis of qualitative studies was conducted. Structured inclusion criteria were applied to screen 616 titles and abstracts, and 9 quali...
Article
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. Objectiv...
Article
Examining environmental factors that influence older adults’ driving patterns has important implications for understanding factors that can lead to self-regulation and cessation. The current study explored the effect of fuel prices on older adults’ driving patterns using objective data from the nationwide Candrive longitudinal study (N = 807). Fuel...
Article
The purpose of this study on driving cessation was to explore the process of coping, decision-making and adaptation through this major life transition. We sought to examine understandings of the emotional responses of drivers and ex-drivers with dementia from the perspective of healthcare providers and family caregivers of persons with dementia. In...
Article
Full-text available
Purpose of ReviewThe purpose of this study was to update a national guideline on assessing drivers with dementia, addressing limitations of previous versions which included a lack of developmental rigor and stakeholder involvement. Methods An international multidisciplinary team reviewed 104 different recommendations from 12 previous guidelines on...
Article
We investigated whether traits from the five-factor model of personality traits (Extraversion, Neuroticism, Agreeableness, Conscientiousness, and Openness-to-Experience) were associated with driving self-regulation – specifically, situational driving frequency (SDF) and situational driving avoidance (SDA). Using data from 324 participants (185 men,...
Article
Background: To determine event rates for specific medical events and mortality among individuals receiving electroconvulsive therapy (ECT). Method: Population-based cohort study using health administrative data of acute ECT treatments delivered in Ontario, Canada, from 2003 to 2011. We measured the following medical event rates, per 10 000 ECT t...
Conference Paper
The Attention Network Test (ANT) measures choice response time (RT) and the efficiency of three functions of attention (alerting, orienting, and executive function). Using data from the Candrive cohort study, we looked for associations between overall median RT from the ANT and traffic violations. Participants (N = 451) were aged ≥70. Violations da...
Article
One of the aims of the Candrive Prospective Older Driver Study was to prospectively identify older drivers who were medically at risk for driving. 928 active older drivers were recruited across 7 Canadian sites and followed up to 7 years. The primary outcome was at-fault collision. Using Generalized Estimating Equations univariate analysis revealed...
Article
The Candrive II cohort researchers have followed a convenient sample of older drivers, aged 70 and older, for five to seven years. One of the goals of this study consists in developing a risk stratification tool that would help identify unsafe older drivers. The validity of such tools depends on how representative the study sample is. We have demon...
Article
We have developed an evidence-based intervention framework to support drivers with dementia and their caregivers when they make decisions about driving, and navigate the process of driving cessation. A range of knowledge creation and synthesis activities were employed, including reviews on relevant topics such as driving cessation interventions, an...
Article
Guidelines that physicians use to assess fitness to drive for dementia are limited in their currency, applicability, and rigour of development. Therefore, we performed a systematic review to determine the risk of motor vehicle collisions (MVCs) or driving impairment caused by dementia, in order to update international guidelines on driving with dem...
Article
Background Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid ph...
Article
Objective: The aim of this project was to review the literature on interventions aimed at facilitating driving cessation in older adults, with and without dementia. Methods: A literature search was performed using the databases MEDLINE, CINAHL, Cochrane Central, Embase, and PsycINFO, from 1994 to September 2014. Two independent raters screened a...
Article
Objectives: The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the p...
Chapter
This is the protocol for a review and there is no abstract. The objectives are as follows: To identify the accuracy of depression rating scales as screening tools for detecting DpD and compare the diagnostic accuracy of different depression rating scales for detecting MDD among adults with Alzheimer's disease and related forms of dementia. To exami...
Article
Full-text available
Geriatric psychiatry was officially recognized as a subspecialty by the Royal College of Physicians and Surgeons of Canada (RCPSC) in 2009, with the first RCPSC exam written in 2013 (Andrew and Shea, 2010). The unique mental health needs of Canadians’ seniors requires geriatric psychiatrists trained to address them (Herrmann, 2004), but current rat...
Article
RÉSUMÉ Nous avons examiné les relations entre la santé perçue (p. ex., l’état de santé auto-évaluation) et des pratiques d’autorégulation de la conduite (p. ex., la fréquence de la conduite, l’evitement des situations de conduite difficiles) comme médiée par les attitudes et les perceptions de conduite (à savoir, le confort de conduite, les attitu...
Article
RÉSUMÉ Nous avons examiné si l’échantillonnage de commodité est une méthode appropriée pour recruter un échantillon de conducteurs âgés représentatif de la population des conducteurs canadiens âgés. En utilisant des tests d’équivalence, nous avons comparé un grand échantillon de commodité de conducteurs âgés (de la cohorte Candrive II) à une popula...
Article
RÉSUMÉ Avec le nombre croissant de conducteurs âgés pour lesquelles on prescrit des antidépresseurs, les conséquences potentielles de l’utilisation des antidépresseurs sur les compétences de conduite dans une population vieillissante deviennent un problème urgent. Nous avons effectué une analyse systématique en utilisant MEDLINE, ciblant des articl...
Article
RÉSUMÉ Dans cette étude, nous avons examiné les données de base Candrive (n = 928; âge de 70 à 94; 62% étaient des hommes) pour analyser si les caractéristiques des conducteurs (âge, sexe, taille, poids, IMC) et certaines capacités fonctionnelles (c’est-à-dire, le test de rythme rapide à pied, le test “Up and Go”) ont influencé les types de véhicul...
Article
RÉSUMÉ Le but de cette étude a été de déterminer si la saison ou la météo, mesurées objectivement, ont affecté les distances des trajets parcourus par les conducteurs âgés (≥ 70 ans, n = 279) à travers sept sites canadiens. Pendant l’hiver, pour tous les voyages effectués, la distance était de 7 pour cent plus court, lors du contrôle pour le site e...
Article
RÉSUMÉ Nous 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 annue...
Article
RÉSUMÉ Les associations entre les variables psychosociaux et les comportements de conduite ont été examinés seulement en coupe transversale à ce jour. Dans cette étude, nous avons utilisé trois vagues de données recueillies chaque année de 928 conducteurs âgés (âge moyen = 76.21 ans; 62% d'hommes) s'inscrits pour la cohorte Candrive II, afin de dét...