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BACKGROUND: This study used various tools, including a self-assessment questionnaire, the Clinical Assessment of Driver-Related Skills (CADReS), and a driving simulation, to discriminate between older and non-older drivers. METHODS: We evaluated driving habits, driving-related health behaviors, and morbidities using a self-assessment questionnaire and examined visual, motor, and cognitive functions using the CADReS and a vehicle simulator of four junction scenarios that are typical of accidents involving older drivers. The areas under the receiver operating characteristic curves (AUCs) were calculated to compare the age-related discriminating ability of these tools between older (≥65 years) and non-older participants. RESULTS: Thirty of the 40 participants (75%) were older. Older drivers were slower than non-older drivers according to the rapid walking pace (8.0 vs. 6.1 seconds), and their cognitive function was poorer based on the trail-making test (117 vs. 51 seconds). While driving on the vehicle simulator, the rate of violating traffic rules was higher and the maximal velocity was slower in the older group than in the non-older group. The AUC values for CADReS and driving simulation outcomes ranged from 0.59 to 0.95, while the rapid walking pace, trail-making test, and velocity of the left turn at an acute junction in the dark showed high discriminatory power (AUC>0.9). CONCLUSIONS: The rapid walking pace and trail-making test in CADReS, as well as the driving simulation, were useful tools to discriminate between older and non-older drivers.
RESUMO
OBJECTIVES: Systemic rheumatic disease is characterized by autoimmunity and systemic inflammation and affects multiple organs. Few studies have investigated whether autoimmune diseases increase the risk of dementia. Herein, we evaluate the relationship between systemic rheumatic disease and dementia through a population-based study using the Korean National Health Insurance Service (NHIS) claims database. METHODS: We conducted a nationwide population-based study using the Korean NHIS database, consisting of individuals who submitted medical claims from 2002-2013. Dementia was defined as having an acetylcholinesterase inhibitors (AChEIs) prescription along with symptoms satisfying the Alzhemier's disease (AD) International Classification of Diseases (ICD)-10 codes (F00 or G30), or vascular dementia (VaD; ICD-10 or F01) criteria. Control subjects were matched to the dementia patients by age and sex. The study group was limited to those diagnosed with rheumatic disease at least 6 months prior to diagnosis of dementia. Rheumatic disease was defined by the following ICD-10 codes: Rheumatoid arthritis (RA: M05), Sjögren's syndrome (SS: M35), systemic lupus erythematosus (SLE: M32), and Behcet's disease (BD: M35.2). RESULTS: Of the 6,028 dementia patients, 261 (4.3%) had RA, 108 (1.6%) had SS, 12 (0.2%) had SLE, and 6 (0.1%) had BD. SLE history was significantly higher in dementia patients (0.2%) than in controls (0.1%) and was associated with dementia (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.19-5.15). In subgroup analysis, SLE significantly increased dementia risk, regardless of dementia type (AD: OR, 2.29; 95% CI, 1.06-4.91; VaD: OR, 4.54; 95% CI, 1.36-15.14). However, these associations were not sustained in the mild CCI or elderly group. CONCLUSION: SLE was independently associated with a higher risk of dementia, including AD and VaD when compared to the control group, even after adjustment. SLE patients (<65 years old) are a high-risk group for early vascular dementia and require screening for early detection and active prevention.