Quantitative assessment of driving performance in Parkinson’s disease

Objectives: The primary aim of this study was to determine how Parkinson’s disease (PD) affects driving performance. It also examined whether changes in driver safety were related to specific clinical disease markers or an individual’s self rating of driving ability. Methods: The driving performance of 25 patients with idiopathic PD and 21 age matched controls was assessed on a standardised open road route by an occupational therapist and driving instructor, to provide overall safety ratings and specific driving error scores. Results: The drivers with PD were rated as significantly less safe (p<0.05) than controls, and more than half of the drivers with PD would not have passed a state based driving test. The driver safety ratings were more strongly related to disease duration (r = −0.60) than to their on time Unified Parkinson’s Disease Rating Scale (r = −0.24). Drivers with PD made significantly more errors than the control group during manoeuvres that involved changing lanes and lane keeping, monitoring their blind spot, reversing, car parking, and traffic light controlled intersections. The driving instructor also had to intervene to avoid an incident significantly more often for drivers with PD than for controls. Interestingly, driver safety ratings were unrelated to an individual’s rating of their own driving performance, and this was the case for all participants. Conclusions: As a group, drivers with PD are less safe to drive than age matched controls. Standard clinical markers cannot reliably predict driver safety. Further studies are required to ascertain whether the identified driving difficulties can be ameliorated.

[1]  S. Greenberg.  Cerebral Amyloid Angiopathy and Vessel Dysfunction , 2002, Cerebrovascular Diseases.

[2]  R. Hauser,et al.  Driving safety in Parkinson’s disease , 2002, Neurology.

[3]  T. Yousry,et al.  Cerebral Microbleeds in CADASIL , 2001 .

[4]  W. Koller,et al.  Driving in Parkinson's disease , 1991, Neurology.

[5]  C. Comella.  Daytime sleepiness, agonist therapy, and driving in Parkinson disease. , 2002, JAMA.

[6]  A. Chaudhuri,et al.  The clinical spectrum, diagnosis, pathogenesis and treatment of Hashimoto's encephalopathy (recurrent acute disseminated encephalomyelitis). , 2003, Current medicinal chemistry.

[7]  Richard S. J. Frackowiak,et al.  Brain responses to changes in bladder volume and urge to void in healthy men. , 2001, Brain : a journal of neurology.

[8]  L. Brain,et al.  Hashimoto's disease and encephalopathy. , 1966, Lancet.

[9]  C H Lücking,et al.  Impairment in preattentive visual processing in patients with Parkinson's disease. , 1999, Brain : a journal of neurology.

[10]  C. Harper,et al.  Reversible MRI findings in a patient with Hashimoto's encephalopathy , 1997, Neurology.

[11]  J. Colebatch,et al.  Hashimoto's encephalopathy responding to plasmapheresis , 2001, Journal of neurology, neurosurgery, and psychiatry.

[12]  C. Svarer,et al.  Cerebral activation during micturition in normal men. , 2000, Brain : a journal of neurology.

[13]  P. Shaw,et al.  Hashimoto's encephalopathy: a steroid-responsive disorder associated with high anti-thyroid antibody titers--report of 5 cases. , 1991, Neurology.

[14]  Liisa Hakamies-Blomqvist,et al.  ELDERLY CAR DRIVERS IN A SIMULATOR: A VALIDATION STUDY , 2000 .

[15]  A. Papassotiropoulos,et al.  The validity of psychometric instruments for detection of dementia in the elderly general population , 1998, International journal of geriatric psychiatry.

[16]  A. Joutel,et al.  Autosomal Dominant Leukoencephalopathy and Subcortical Ischemic Stroke: A Clinicopathological Study , 1993, Stroke.

[17]  C. Worringham,et al.  Practice effects in three‐dimensional sequential rapid aiming in Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[18]  J. Hulley,et al.  Parkinson's disease and driving ability. , 1990, Journal of neurology, neurosurgery, and psychiatry.

[19]  M. Dichgans,et al.  The phenotypic spectrum of CADASIL: Clinical findings in 102 cases , 1998, Annals of neurology.

[20]  M. Viitanen,et al.  CADASIL: a Common Form of Hereditary Arteriopathy Causing Brain Infarcts and Dementia , 2002, Brain pathology.

[21]  G. Moretto,et al.  Antithyroid antibodies in the CSF , 2003, Neurology.

[22]  C. N. Homann,et al.  Sleep attacks in patients taking dopamine agonists: review , 2002, BMJ : British Medical Journal.

[23]  M. K. Campbell,et al.  Medical conditions associated with driving cessation in community-dwelling, ambulatory elders. , 1993, Journal of gerontology.

[24]  W. Bradley.  Cystometry and sphincter electromyography. , 1976, Mayo Clinic proceedings.

[25]  A. Demchuk,et al.  The probability of middle cerebral artery MRA flow signal abnormality with quantified CT ischaemic change: targets for future therapeutic studies , 2004, Journal of Neurology, Neurosurgery & Psychiatry.

[26]  A. Joutel,et al.  Transgenic mice expressing mutant Notch3 develop vascular alterations characteristic of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. , 2003, The American journal of pathology.

[27]  Ruchoux,et al.  Endothelial changes in muscle and skin biopsies in patients with CADASIL , 1998, Neuropathology and applied neurobiology.

[28]  L. Rowland,et al.  Hashimoto encephalopathy: syndrome or myth? , 2003, Archives of neurology.

[29]  寒河江純平,et al.  [CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)]. , 1997, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[30]  S. Swinnen,et al.  Bimanual coordination and limb-specific parameterization in patients with Parkinson's disease , 2000, Neuropsychologia.

[31]  R. Gilmore,et al.  Electroencephalographic findings in Hashimoto's encephalopathy , 1995, Neurology.

[32]  G McGwin,et al.  Identifying crash involvement among older drivers: agreement between self-report and state records. , 1998, Accident; analysis and prevention.

[33]  J. Wood,et al.  Age and Visual Impairment Decrease Driving Performance as Measured on a Closed-Road Circuit , 2002, Hum. Factors.

[34]  H. Summala,et al.  Decreased driving ability in people with Parkinson’s disease , 1998, Journal of neurology, neurosurgery, and psychiatry.

[35]  Ryuji Sakakibara,et al.  Micturitional disturbance after acute hemispheric stroke: analysis of the lesion site by CT and MRI , 1996, Journal of the Neurological Sciences.

[36]  J. Weissenbach,et al.  Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia , 1996, Nature.

[37]  J. Dichgans,et al.  Manifestation of Hashimoto’s Encephalopathy Years before Onset of Thyroid Disease , 1999, European Neurology.

[38]  C. Tanner,et al.  Plantation work and risk of Parkinson disease in a population-based longitudinal study. , 2002, Archives of neurology.

[39]  Nils Peters,et al.  Cerebral Microbleeds in CADASIL: A Gradient-Echo Magnetic Resonance Imaging and Autopsy Study , 2002, Stroke.

[40]  G. Ivanic,et al.  Driving in Parkinson’s disease—a health hazard? , 2003, Journal of Neurology.

[41]  N. Lincoln,et al.  The effects of cognitive abilities on driving in people with Parkinson's disease , 2004, Disability and rehabilitation.

[42]  Kathy A. Low,et al.  Response slowing in Parkinson's disease: a psychophysiological analysis of premotor and motor processes. , 2002, Brain : a journal of neurology.

[43]  A. Lteif,et al.  Steroid-responsive encephalopathy associated with Hashimoto's thyroiditis in an adolescent with chronic hallucinations and depression: case report and review. , 2003, Pediatrics.

[44]  J. Wood,et al.  Comparison of Driving Performance of Young and Old Drivers (with and without Visual Impairment) Measured during In-Traffic Conditions , 2001, Optometry and vision science : official publication of the American Academy of Optometry.

[45]  S Lings,et al.  Driving with Parkinson's disease: A controlled laboratory investigation , 1992, Acta neurologica Scandinavica.