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Abstract
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The revised Road Traffic Law was enforced in Japan in March 2017 and cognitive decline has since been pointed out during driverʼs license renewal, thus the number of elderly people who visit hospitals has increased in Japan.
The number of elderly people who visit our clinic for the purpose of preparing a medical certificate for renewing their driver's license is increasing, and we investigated the current situation.
During the 29 months from March 2017 to July 2019, 290 patients visited our clinic.
Among them, a decline in cognitive function while renewing their driver's license was noted in 25 and they consulted for the purpose of preparing a medical certificate. We examined the cognitive function tests performed by the Prefectural Public Safety Commission, the neuropsychological tests（HDS-R, MMSE, FAB, CDR, TMT, MoCa-J）performed at our clinic, and their current driving status.
The 25 patients comprised 22 men and 3 women, with an average age of 80 ± 4.1 years and average educational history of 10.5 ± 2.7 years. The median total score of cognitive function tests conducted by the Prefectural Public Safety Commission was 35 points. In addition, the median scores of neuropsychological tests performed at our clinic were HDS-R: 17, MMSE: 21, FAB: 10, and CDR: 0.5 for 14 patients, and CDR: 1.0 or higher for 11 patients. The TMT-A score was lower than the age average for 8 subjects（out of 25）and the TMT-B score was lower than the age average 18 for（out of 21）. As a result, three of the 25 patients were diagnosed with mild cognitive impairment and continued driving, and 22 were diagnosed with dementia or suspected dementia, and voluntarily returned their driving license.
Interviews with the patients revealed that their family noted their cognitive decline in 64％, but they only noted a high accident risk of driving in 24％.
In Fukui Prefecture where our clinic is located, elderly drivers need cars. Some of the elderly drivers can drive with a low accident risk even if cognitive function is reduced. On the other hand, in many cases, their family members do not notice that they have dementia; therefore, it is necessary to sufficiently interview them regarding daily life and to examine cognitive functions in many fields to determine whether they can continue driving.
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2017年3月に改正道路交通法が施行され、運転免許更新時に認知機能低下の指摘を受け、都道府県公安委員会からの診断書提出命令書を持参し医療機関を受診する症例が増えている。当院でも診断書作成目的に受診する患者が目立つようになり、その現状を調査した。2017年3月〜2019年7月までの29カ月間に当院物忘れ外来を受診した患者290名のうち、診断書提出命令書を持参した25名を対象とし、公安委員会で施行した認知機能検査、当院で施行した神経心理検査〔HDS-R、MMSE、FAB、CDR（Clinical Dementia Rating）、TMT（Trail Making Test）、MoCA-J（日本語版Montreal Cognitive Assessment）〕、現在の運転状況について検討した。25名（男性22名、年齢80±4.1歳、教育歴10.5±2.7年）の認知機能検査の総合点は中央値35点であった。また神経心理検査の中央値はそれぞれHDS-R 17点、MMSE 21点、FAB 10点であり、CDRは0.5が14名、1.0以上が11名であった。TMT-Aは、年齢平均以下は25名中8名、TMT-Bは、年齢平均以下は21名中18名であった。この結果25名中3名は軽度認知障害で診断書を提出、22名は認知症あるいは認知症疑いと診断し自主返納となった。問診からは、患者家族の64％は患者の認知機能低下を感じていたが、患者の運転に危険を感じている家族は24％のみであった。当院のある福井県では、高齢運転者が多く、車の必要性は高い。高齢運転者の中には、明らかに認知機能低下がみられても、運転に危険を感じず運転できている現状がある。一方で、家族が患者を認知症との目で見ていない場合も多く、運転の判断には、日常生活などの十分な問診と、多方面の認知機能の検討が必要と思われる。
Language: ja |