[Automobile driving capacity in dementia]. / Fahreignung bei Demenz-Erkrankungen.

Dementia influences at an early stage the driving aptitude of motor vehicle steering persons. Every year in Switzerland, around 16'000 driving permit holders suffer newly from dementia; therefore the driving aptitude is questioned, especially because of possibly limited executive functions. Individuals with early-stage dementia often may show a dangerous driving stile. However, a mild dementia does not a priori exclude the driving aptitude, and less than half of these drivers can continue driving for another 1 - 3 years. In contrast, there is no further driving aptitude in presence of moderate dementia. In the assessment of driving aptitude, the underlying cause of dementia is always taken into account. Cognitive short tests such as the Mini-Mental Status Exam, Clock Drawing Test and Trail-Making Test are not suitable to make reliable statements about the aptitude to drive, but these tests are very important for the initial diagnosis of dementia in primary care practice and can lead the way for further examination concerning driving aptitude. The legally prescribed regular check-up for motorists aged over 70 years in Switzerland provides an ideal opportunity for early detection of incipient dementia. The practical procedure for the assessment of aptitude to drive in the primary care practice is presented. The physician-guided on-road driving test represents a meaningful, practical and relatively cost-effective tool for the evaluation of driving aptitude in cases of doubt.

[Traffic medicine in basic medical practice]. / Verkehrsmedizin in der Grundversorger-Praxis.

Many consequences of an illness or an accident that are treated in the form of basic medical practice consequences concerned can either be directly caused by the illness or accident, or result from the ensuing treatment. A physician providing basic medical care is therefore often confronted with traffic medicine issues. Moreover, most Swiss cantons have charged general practitioners with carrying out the legally prescribed regular check-ups for motorists aged over 70. General practitioners thus assume the role of medical examiner for these bi-annual check-ups. This paper discusses basic aspects in connection with general practitioners' evaluation of a person's aptitude for driving and with frequent traffic medicine issues dealt with in basic medical practice. Special emphasis is placed on best practice in the regular check-ups for over 70-year-old motorists.

[Driving ability and fitness to drive in people with diabetes mellitus]. / Fahreignung und Fahrfähigkeit bei Diabetes mellitus.

Chronic sequelae of diabetes that could potentially affect driving include the following: visual retinopathy with associated impaired visual acuity, loss of peripheral vision and poor dark adaptation; neuropathy that may affect lower limb functions needed for safe driving; and acute events, including transient cognitive dysfunction and loss of consciousness related to hypo- or hyperglycemia. Hyperglycemia does not suddenly incapacitate drivers, however its occurrence often leads to tiredness, blurred vision, decreased visual acuity and adjustment of treatment which may precipitate hypoglycaemia. The side effects of acute hypoglycemia are of particular concern, as they include slowing of both cognitive and motor functions. Hypoglycemia while driving ist the most important complication in persons treated with insulin, sulfonylureas or glinides. They can be prevented, however, by frequent measuring blood glucose before and every 60 to 90 minutes during driving, by keeping sugary snacks (carbohydrates) in the vehicle, and by taking carbohydrates in case of glucose levels below 5 mmol/l. For patients, who are treated with insulin and sulfonylureas/glinides, it is of utmost importance fort the treating physician to frequently talk about successful strategies for preventing hypoglycemias, and thus accidents, while driving. People with diabetes treated with insulin, sulfonylureas or glinides are nor allowed to drive a bus, taxi, or truck (commercial driving). Under special circumstances (evalution and treatment by a diabetologist/endocrinolgist, avoidance of hypoglycemias for three months, and frequent glucose measurements) an exception to this rule can be granted for truck and cab drivers (after a thorough licensing examination).

Saccadic eye movement performance as an indicator of driving ability in elderly drivers.

OBJECTIVE: Regular checking of the fitness to drive of elderly car-license holders is required in some countries, and this will become increasingly important as more countries face aging populations. The present study investigated whether the analysis of saccadic eye movements could be used as a screening method for the assessment of driving ability. METHODS: Three different paradigms (prosaccades, antisaccades, and visuovisual interactive (VVI) saccades) were used to test saccadic eye movements in 144 participants split into four groups: elderly drivers who came to the attention of road authorities for suspected lack of fitness to drive, a group of elderly drivers who served as a comparison group, a group of neurology patients with established brain lesion diagnoses, and a young comparison group. The group of elderly drivers with suspected deficits in driving skills also underwent a medical examination and a practical on-road driving test. The results of the saccadic eye tests of the different groups were compared. RESULTS: Antisaccade results indicated a strong link to driving behaviour: elderly drivers who were not fit to drive exhibited a poor performance on the antisaccade task and the performance in the VVI task was also clearly poorer in this group. CONCLUSIONS: Testing saccadic eye movements appears to be a promising and efficient method for screening large numbers of people such as elderly drivers. This study indicated a link between antisaccade performance and the ability to drive. Hence, measuring saccadic eye movements should be considered as a tool for screening the fitness to drive.