Citation

Thompson T, Poulter D, Miles C, Solmi M, Veronese N, Carvalho AF, Stubbs B, Uc EY. Neurology 2018; 91(10): e906-e916.

Affiliation

From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0000000000006132

PMID

30076275

Abstract

OBJECTIVES: To provide the best possible evidence base for guiding driving decisions in Parkinson disease (PD), we performed a meta-analysis comparing patients with PD to healthy controls (HCs) on naturalistic, on-the-road, and simulator driving outcomes.

METHODS: Seven major databases were systematically searched (to January 2018) for studies comparing patients with PD to HCs on overall driving performance, with data analyzed using random-effects meta-analysis.

RESULTS: Fifty studies comprising 5,410 participants (PD = 1,955, HC = 3,455) met eligibility criteria. Analysis found the odds of on-the-road test failure were 6.16 (95% confidence interval [CI] 3.79-10.03) times higher and the odds of simulator crashes 2.63 (95% CI 1.64-4.22) times higher for people with PD, with poorer overall driving ratings also observed (standardized mean differences from 0.50 to 0.67). However, self-reported real-life crash involvement did not differ between people with PD and HCs (odds ratio = 0.84, 95% CI 0.57-1.23, p = 0.38).

FINDINGS remained unchanged after accounting for any differences in age, sex, and driving exposure, and no moderating influence of disease severity was found.

CONCLUSIONS: Our findings provide persuasive evidence for substantive driving impairment in PD, but offer little support for mandated PD-specific relicensure based on self-reported crash data alone, and highlight the need for objective measures of crash involvement.

© 2018 American Academy of Neurology.

Language: en