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Citation
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Badenes D, Garolera M, Casas L, Cejudo JC, Zaragoza S, Calzado N, Aguilar M. Traffic Injury Prev. 2018; 19(2): 125-132. |
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Affiliation
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g Neurologist, Servei de Neurologia, Hospital Universitari Mutua Terrassa, Terrassa, Spain. Phone: 0034937365050 . |
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Abstract
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OBJECTIVE To determine whether the standard Spanish driving test (ASDE test) was able to identify patients with Parkinson's disease (PD) at risk of unsafe driving, and to examine the relationship between the ASDE test and the UFOV as well as with a battery of neuropsychological tests in PD drivers.
METHODS Thirty-seven PD patients and 33 controls matched by age and education level were included in an observational study. All participants were active drivers and PD patients underwent study procedures after taking the medication in the "on" period. Subjects with a Mini-Mental State Examination (MMSE) score ≤ 24 were excluded. Neuropsychological tests (Repeatable Battery for Neuropsychological Status [RBANS], Trail Making Test [TMT-A&B] and Block Design test), driving performance tests (ASDE Driver-Test and Useful Field of View [UFOV]) and daytime sleepiness (Epworth Sleepiness Scale) were assessed.
RESULTS The PD group performed significantly worse than healthy controls in the ASDE Motor Coordination tests. In Anticipation Speed, Multiple Reaction Time, Concentrated Attention and Resistance to Monotony no significant differences were observed. All participants completed successfully the UFOV tests. Statistically differences between PD patients and controls were found in Processing Speed (UFOV1) (P = 0.03) and more PD patients were found in the categories of higher driving risk levels (P = 0.03). Also, PD patients showed worse scores than healthy controls in visuospatial capacities (line orientation), psychomotor speed (coding and TMT-A), memory (list recognition, story recall) and executive function (TMT-B). The driving tests (ASDE and UFOV) showed a low sensitivity and a high specificity but a higher percentage of patients in the PD group failed in Multiple Reaction Time, and Concentrated Attention and Resistance to Monotony. Also, 18.9% of PD patients showed a cutoff of 4 for UFOV risk. In the discriminant analysis, Line Orientation (visuospatial/constructive domain) and Figure Recall (delayed memory) were found to be statistically significant with a rate of correct classification of unsafe PD drivers of 78.2%. Also, normal results in the Line Orientation item was associated with 1.5 higher probability of non-risky driving in the multivariate analysis.
CONCLUSIONS At early stages of the disease about 19% of PD patients showed difficulties that may affect their driving capabilities. Line Orientation and Figure Recall are useful to alert clinicians to the risk of unsafe driving. For this reason, patients with PD should be evaluated for driving abilities more regularly to determine the extent of deficits that may influence driving performance.
Language: en |