Fitness-to-drive recommendations in post-stroke patients: a retrospective study.

BACKGROUND: Stroke sequelae can have an impact on daily life activities such as driving. French legislation stipulates that post-stroke patients should undergo a multi-professional fitness-to-drive assessment before being allowed to drive again. This retrospective study aims to explore the determinants of multi-professional fitness-to-drive recommendations. METHODS: Sixty-six post-stroke patients assessed for fitness to drive in the Kerpape Center, France in 2019 were included. Favorable or unfavorable driving recommendations were attributed to patients following a joint decision by a multi-professional team. Individual characteristics obtained from medical records were compared. RESULTS: Findings showed that 64% of stroke patients received a favorable fitness-to-drive recommendation. Across all demographic, clinical, and driving characteristics, the time interval between stroke and assessment was significantly longer for patients designated as unfit to drive than for those designated as fit to drive (P = .004). Furthermore, the proportion of instrumental sequelae was higher in patients designated as unfit to drive than in those designated as fit to drive (P = .022). Stepwise logistic regression showed that the presence of instrumental sequelae, mainly aphasia, was the best predictor of fitness-to-drive recommendations. CONCLUSIONS: The post-stroke time interval and the presence of instrumental sequelae explained the difference between patients recommended as fit-to-drive and unfit-to-drive. Furthermore, aphasia was found be the best predictor of a fitness-to-drive recommendation. It is possible that aphasia impacts the understanding of instructions during on-road testing. These findings emphasize the need for a standardized multi-professional fitness-to-drive assessment, since the determinants of fitness-to-drive recommendation differ between studies.

Driving Automation for Older Adults with Preclinical Alzheimer's Disease.

INTRODUCTION: Older adults with preclinical Alzheimer's disease (AD) show changes in on-road driving performance. The impact of preclinical AD on using automated vehicle (AV) technology is unknown. The aim was to evaluate safety and cognitive workload while operating AV technology in drivers with preclinical AD. INTRODUCTION: This cross-sectional study included 40 participants: 19 older adults (age 74.16 ± 4.78; MOCA scores 26.42 ± 2.52) with preclinical AD, evidenced by elevated cortical beta-amyloid; and 21 controls (age 73.81 ± 5.62; MOCA scores 28.24 ± 1.67). All participants completed two scenarios in a driving simulator. Scenario 1 included conditional automation with an emergency event that required a manual take-over maneuver. Scenario 2 was identical but with a cognitive distractor task. Emergency response time was the main safety outcome measure. Cognitive workload was calculated using moment-to-moment changes in pupillary size and converted into an Index of Cognitive Activity (ICA). Mann-Whitney U and independent t tests were used to compare group differences. RESULTS: Emergency response times were similar between drivers with preclinical AD and controls in scenario 1 (20.85 s ± 1.08 vs. 20.52 s ± 3.18; p = 0.83) and scenario 2 (14.83 s ± 7.37 vs. 13.45 s ± 10.43; p = 0.92). Likewise, no differences were found in ICA between drivers with preclinical AD and controls in scenario 1 (0.34 ± 0.08 vs. 0.33 ± 0.17; p = 0.74) or scenario 2 (0.30 ± 0.07 vs. 0.29 ± 0.17; p = 0.93). CONCLUSIONS: Older drivers with preclinical AD may safely operate AV technology, without increased response times or cognitive workload. Future on-road studies with AV technology should confirm these preliminary results in drivers with preclinical AD.

Left and Right Cortical Activity Arising from Preferred Walking Speed in Older Adults.

Cortical activity and walking speed are known to decline with age and can lead to an increased risk of falls in the elderly. Despite age being a known contributor to this decline, individuals age at different rates. This study aimed to analyse left and right cortical activity changes in elderly adults regarding their walking speed. Cortical activation and gait data were obtained from 50 healthy older individuals. Participants were then grouped into a cluster based on their preferred walking speed (slow or fast). Analyses on the differences of cortical activation and gait parameters between groups were carried out. Within-subject analyses on left and right-hemispheric activation were also performed. Results showed that individuals with a slower preferred walking speed required a higher increase in cortical activity. Individuals in the fast cluster presented greater changes in cortical activation in the right hemisphere. This work demonstrates that categorizing older adults by age is not necessarily the most relevant method, and that cortical activity can be a good indicator of performance with respect to walking speed (linked to fall risk and frailty in the elderly). Future work may wish to explore how physical activity training influences cortical activation over time in the elderly.

An innovative therapeutic educational program to support older drivers with cognitive disorders: Description of a randomized controlled trial study protocol.

Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the "Current Self-Regulatory Practices" subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary. Clinical trial registration number: NCT04493957.

Measuring the Cognitive Workload During Dual-Task Walking in Young Adults: A Combination of Neurophysiological and Subjective Measures.

Background: Walking while performing a secondary task (dual-task (DT) walking) increases cognitive workload in young adults. To date, few studies have used neurophysiological measures in combination to subjective measures to assess cognitive workload during a walking task. This combined approach can provide more insights into the amount of cognitive resources in relation with the perceived mental effort involving in a walking task. Research Question: The objective was to examine cognitive workload in young adults during walking conditions varying in complexity. Methods: Twenty-five young adults (mean = 24.4 ± 5.4) performed four conditions: (1) usual walking, (2) simple DT walking, (3) complex DT walking and (4) standing while subtracting. During the walking task, mean speed, cadence, stride time, stride length, and their respective coefficient of variation (CV) were recorded. Cognitive workload will be measured through changes in oxy- and deoxy-hemoglobin (ΔHbO2 and ΔHbR) during walking in the dorsolateral prefrontal cortex (DLPFC) and perceived mental demand score from NASA-TLX questionnaire. Results: In young adults, ΔHbO2 in the DLPFC increased from usual walking to both DT walking conditions and standing while subtracting condition. ΔHbO2 did not differ between the simple and complex DT and between the complex DT and standing while subtracting condition. Perceived mental demand gradually increased with walking task complexity. As expected, all mean values of gait parameters were altered according to task complexity. CV of speed, cadence and stride time were significantly higher during DT walking conditions than during usual walking whereas CV of stride length was only higher during complex DT walking than during usual walking. Significance: Young adults had greater cognitive workload in the two DT walking conditions compared to usual walking. However, only the mental demand score from NASA-TLX questionnaire discriminated simple from complex DT walking. Subjective measure provides complementary information to objective one on changes in cognitive workload during challenging walking tasks in young adults. These results may be useful to improve our understanding of cognitive workload during walking.

Changes in Prefrontal Cortical Activity During Walking and Cognitive Functions Among Patients With Parkinson's Disease.

Background: Walking becomes more and more degraded as Parkinson's Disease (PD) progresses. Previous research examined factors contributing to this deterioration. Among them, changes in brain cortical activity during walking have been less studied in this clinical population. Objectives: This study aimed to: (1) investigate changes in dorsolateral prefrontal cortex (DLPFC) activation during usual walking and dual-task walking conditions in patients with PD; (2) examine the association between cortical activity and behavioral/cognitive outcomes; and (3) explore which factors best predict increased activation of the DLPFC during usual walking. Methods: Eighteen patients with early stage PD and 18 controls performed 4 conditions: (1) standing while subtracting, (2) usual walking, (3) walking while counting forward, and (4) walking while subtracting. Cortical activity in DLPFC, assessed by changes in oxy-hemoglobin (ΔHbO2) and deoxy-hemoglobin (ΔHbR), was measured using functional near infrared spectroscopy (fNIRS). Gait performance was recorded using wearables sensors. Cognition was also assessed using neuropsychological tests, including the Trail Making Test (TMT). Results: DLPFC activity was higher in patients compared to controls during both usual walking and walking while subtracting conditions. Patients had impaired walking performance compared to controls only during walking while subtracting task. Moderate-to-strong correlations between ΔHbO2 and coefficients of variation of all gait parameters were found for usual walking and during walking while counting forward conditions. Part-B of TMT predicted 21% of the variance of ΔHbO2 during usual walking after adjustment for group status. Conclusions: The increased DLPFC activity in patients during usual walking suggests a potential compensation for executive deficits. Understanding changes in DLPFC activity during walking may have implications for rehabilitation of gait in patients with PD.

Driving in Parkinson Disease.

Driving is impaired in most patients with Parkinson disease because of motor, cognitive, and visual dysfunction. Driving impairments in Parkinson disease may increase the risk of crashes and result in early driving cessation with loss of independence. Drivers with Parkinson disease should undergo comprehensive evaluations to determine fitness to drive with periodic follow-up evaluations as needed. Research in rehabilitation of driving and automation to maintain independence of patients with Parkinson disease is in progress.

Brain activity during dual task gait and balance in aging and age-related neurodegenerative conditions: A systematic review.

The aims of this systematic review were to investigate (1) real-time brain activity during DT gait and balance, (2) whether changes in brain activity correlate with changes in behavioral outcomes in older adults and people with age-related neurodegenerative conditions. PubMed, PsycINFO, and Web of Science were searched from 2009 to 2019 using the keywords dual task, brain activity, gait, balance, aging, neurodegeneration, and other related search terms. A total of 15 articles were included in this review. Functional near-infrared spectroscopy and electroencephalogram measures demonstrated that older adults had higher brain activity, particularly in the prefrontal cortex (PFC), compared to young adults during dual task gait and balance. Similar neurophysiological results were observed in people with age-related neurodegenerative conditions. Few studies demonstrated a relationship between increased brain activity and better behavioral outcomes. This systematic review supports the notion that aging and age-related neurodegenerative conditions are associated with neuronal network changes, resulting in increased brain activity specifically in the PFC. Further studies are warranted to assess the relationship between increased PFC activation during dual task gait and balance and behavioral outcomes to better optimize the rehabilitation interventions.

Hemodynamic responses to visual cues during attentive listening in autonomous versus manual simulated driving: A pilot study.

Emerging automation technologies could have a strong impact on the allocation of drivers' attentional resources. The first objective of this pilot study is to investigate the hemodynamic responses evoked to relevant visual stimuli in manual and autonomous driving. The second aim is to examine how the inclusion of a secondary task (attentive listening to a broadcast) modulates these hemodynamic responses in both driving situations. Frontal, temporo-parietal and occipital activations were recorded using a functional Near-InfraRed Spectroscopy (fNIRS) system. Event-related analysis was used to determine whether visual cue processing (specifically, the lighting of a lead vehicle's brake-lights) could induce different brain responses depending on the driving mode and on the presence or absence of a competing task. Mind-wandering as reported by the participants was more pronounced during autonomous compared to manual driving. Our results showed an increase in the OxyHb concentration in the right temporo-parietal and occipital areas during manual compared to autonomous driving, suggesting greater allocation of attentional resources for processing visual cues in the first condition. Finally, an event-related decrease in right frontal activity during autonomous driving when listening was observed, suggesting that attentional resources were more focused on the secondary task than on monitoring the driving scene.

Performance-based visual field testing for drivers with glaucoma: A pilot study.

OBJECTIVE: Conventional visual field (VF) tests are limited in predicting on-road driving performance of individuals with glaucoma. We developed a new performance-based VF test in a driving simulator for individuals with glaucoma. The aim was to evaluate the psychometric properties of the newly developed test. METHODS: In this pilot study, 17 drivers with glaucoma aged 65.24 ± 9.69 and 13 control drivers aged 61.27 ± 11.45 completed the performance-based VF task. Construct validity was determined by comparing performance on the new task with results on conventional visual and perimetry tests including Humphrey Visual Field Analyzer, Keystone Vision Screener, and Useful Field of View (UFOV). Concurrent validity was evaluated by comparing performance on the new task with on-road driving performance, scored using the Test Ride for Investigating Practical fitness-to-drive (TRIP). Ten individuals (7 with glaucoma and 3 controls) participated in the test-retest reliability assessment. RESULTS: Drivers with glaucoma identified fewer symbols (P = .047) and took longer to respond to the symbols (P = .048) compared to controls. In the glaucoma group, correct responses on the performance-based VF test correlated strongly (r = -0.51, P = .046) with UFOV divided attention. Both glaucoma and control groups achieved submaximal to maximal scores on the TRIP (median [Q1-Q3], glaucoma: 193 [191-196]; controls: 196 [195-196]; P = .16). No strong correlations were found between scores on the performance-based VF test and on-road driving performance in glaucoma. The intraclass correlation coefficients ranged between 0.77 for response time and 0.92 for correct responses, indicating good to excellent test-retest reliability. CONCLUSIONS: We established the construct validity and test-retest reliability of the performance-based VF test. Future studies should include a larger sample with more severe driving difficulties to demonstrate the concurrent validity between performance-based VF testing and on-road driving performance in glaucoma.

The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions.

BACKGROUND: Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. OBJECTIVE: To investigate the effect of advanced age on driving safety in drivers with medical conditions. METHODS: We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55-64 years, n = 1,386), young-old (65-74 years, n = 1,013), old-old (75-84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. RESULTS: The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20-9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87-4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88-4.12) compared to the middle-aged. CONCLUSION: Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs.

Effect of Cognitive Demand on Functional Visual Field Performance in Senior Drivers with Glaucoma.

Purpose: To investigate the effect of cognitive demand on functional visual field performance in drivers with glaucoma. Method: This study included 20 drivers with open-angle glaucoma and 13 age- and sex-matched controls. Visual field performance was evaluated under different degrees of cognitive demand: a static visual field condition (C1), dynamic visual field condition (C2), and dynamic visual field condition with active driving (C3) using an interactive, desktop driving simulator. The number of correct responses (accuracy) and response times on the visual field task were compared between groups and between conditions using Kruskal-Wallis tests. General linear models were employed to compare cognitive workload, recorded in real-time through pupillometry, between groups and conditions. Results: Adding cognitive demand (C2 and C3) to the static visual field test (C1) adversely affected accuracy and response times, in both groups (p < 0.05). However, drivers with glaucoma performed worse than did control drivers when the static condition changed to a dynamic condition [C2 vs. C1 accuracy; glaucoma: median difference (Q1-Q3) 3 (2-6.50) vs. CONTROLS: 2 (0.50-2.50); p = 0.05] and to a dynamic condition with active driving [C3 vs. C1 accuracy; glaucoma: 2 (2-6) vs. CONTROLS: 1 (0.50-2); p = 0.02]. Overall, drivers with glaucoma exhibited greater cognitive workload than controls (p = 0.02). Conclusion: Cognitive demand disproportionately affects functional visual field performance in drivers with glaucoma. Our results may inform the development of a performance-based visual field test for drivers with glaucoma.

Comparison of Unsafe Driving Across Medical Conditions.

OBJECTIVE: To compare risks of unsafe driving in patients with medical conditions. METHODS: This large population-based study included all patients who were referred for a fitness-to-drive evaluation at an official driving evaluation center in 2013 and 2014. Risks of unsafe driving included physician's fitness-to-drive recommendation, comprehensive fitness-to-drive decision, motor vehicle crash history, and traffic violation history. RESULTS: A total of 6584 patients were included in the study. Risks of unsafe driving were significantly different across medical conditions (P<.001 for all outcome measures). Patients with neurological conditions comprised the majority of the database (4837; 74%), but were not at the highest risk for unsafe driving. Patients with psychiatric conditions or substance abuse did worse on most driving safety outcomes, despite their low representation in the total sample (359 [6%] and 46 [1%], respectively). CONCLUSION: The risk of unsafe driving varied greatly across medical conditions. Sensitization campaigns, education, and medical guidelines for physicians and driver licensing authorities are warranted to identify patients at risk, especially for those with psychiatric conditions and substance abuse problems.

Cognitive workload across the spectrum of cognitive impairments: A systematic review of physiological measures.

Our objective was to identify the physiological measures that are sensitive to assessing cognitive workload across the spectrum of cognitive impairments. Three database searches were conducted: PubMed, PsychINFO, and Web of Science. Studies from the last decade that used physiological measures of cognitive workload in older adults (mean age >65 years-old) were reviewed. The cognitive workload of healthy older individuals was compared with the cognitive workload of younger adults, patients with mild cognitive impairment (MCI), and patients with Alzheimer's diseases (AD). The most common measures of cognitive workload included: electroencephalography, magnetoencephalography, functional magnetic resonance imaging, pupillometry, and heart rate variability. These physiological measures consistently showed greater cognitive workload in healthy older adults compared to younger adults when performing the same task. The same was observed in patients with MCI compared to healthy older adults. Behavioral performance declined when the available cognitive resources became insufficient to cope with the cognitive demands of a task, such as in AD. These findings may have implications for clinical practice and future cognitive interventions.

Emulation of Physician Tasks in Eye-Tracked Virtual Reality for Remote Diagnosis of Neurodegenerative Disease.

For neurodegenerative conditions like Parkinson's disease, early and accurate diagnosis is still a difficult task. Evaluations can be time consuming, patients must often travel to metropolitan areas or different cities to see experts, and misdiagnosis can result in improper treatment. To date, only a handful of assistive or remote methods exist to help physicians evaluate patients with suspected neurological disease in a convenient and consistent way. In this paper, we present a low-cost VR interface designed to support evaluation and diagnosis of neurodegenerative disease and test its use in a clinical setting. Using a commercially available VR display with an infrared camera integrated into the lens, we have constructed a 3D virtual environment designed to emulate common tasks used to evaluate patients, such as fixating on a point, conducting smooth pursuit of an object, or executing saccades. These virtual tasks are designed to elicit eye movements commonly associated with neurodegenerative disease, such as abnormal saccades, square wave jerks, and ocular tremor. Next, we conducted experiments with 9 patients with a diagnosis of Parkinson's disease and 7 healthy controls to test the system's potential to emulate tasks for clinical diagnosis. We then applied eye tracking algorithms and image enhancement to the eye recordings taken during the experiment and conducted a short follow-up study with two physicians for evaluation. Results showed that our VR interface was able to elicit five common types of movements usable for evaluation, physicians were able to confirm three out of four abnormalities, and visualizations were rated as potentially useful for diagnosis.

Driving after Concussion: Is It Safe To Drive after Symptoms Resolve?

Post-concussion impairments may result in unsafe driving performance, but little research is available to guide consensus on when concussed individuals should return to driving. The purpose of this study was to compare driving performance between individuals with and without a concussion and to explore relationships between neuropsychological and driving performance. Fourteen participants with concussion (age 20.2 ± 0.9 years old) and 14 non-concussed age- and driving experience-matched controls (age 20.4 ± 1.1 years old) completed a graded symptom checklist, a brief neuropsychological exam, and a 20.5 km driving simulation task. Participants with a concussion completed driving simulation within 48 h of becoming asymptomatic (15.9 ± 9.0 days post-concussion). One-way analyses of variance were used to compare total number of crashes, tickets, and lane excursions, as well as standard deviation of lateral position (SDLP) and standard deviation of speed. Pearson's correlations were conducted to explore the relationship between the neuropsychological and driving performance separately by group (α = 0.05). Participants with a concussion committed more frequent lane excursions (concussed 10.9 ± 4.5; controls 7.4 ± 2.4; p = 0.017) and exhibited greater SDLP, compared with controls, during the first curve (concussed 45.7 ± 21.3 cm, controls 27.4 ± 6.1 cm; p = 0.030) and final curve (concussed 39.6 ± 24.4 cm; controls 33.5 ± 21.3 cm; p = 0.036). Poorer performance on symbol digit modalities (r = -0.54), Rey Osterrieth Complex Figure (r = -0.53), verbal memory (r = -0.77), and motor speed (r = -0.54) were correlated with more frequent lane excursions in the concussed group, but not in the control group. Despite being asymptomatic, concussed participants exhibited poorer vehicle control, especially when navigating curves. Driving impairments may persist beyond when individuals with a concussion have returned to driving. Our study provides preliminary guidance regarding which neuropsychological functions may best indicate driving impairment following concussion.

Determinants of On-Road Driving in Multiple Sclerosis.

OBJECTIVE: To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS). DESIGN: Prospective cross-sectional study. SETTING: MS clinic and driving simulator lab. PARTICIPANTS: Active drivers (N=102) with various types of MS. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster. RESULTS: Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25). CONCLUSIONS: Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.

Fitness-to-drive Disagreements in Individuals With Dementia.

Purpose of the Study: We sought to investigate the agreement between medical and practical fitness-to-drive recommendations in active drivers with dementia. Design and Methods: In this retrospective study, 68 patients underwent medical, visual, and road tests at an official center of the Belgian Road Safety Institute. Physicians provided medical fitness-to-drive recommendations using 1 of 3 categories (favorable, reserved, or unfavorable). On-road assessors used the same 3 categories to make practical fitness-to-drive recommendations. Agreement between the medical and practical fitness-to-drive recommendations was calculated using the percentage of agreement (p0) and weighted kappa (kw). Results: Low agreement was found between physicians and on-road assessors regarding their fitness-to-drive recommendations (p0 = 43%, kw = 0.11, p = .20). Compared with the on-road assessors, the physicians overestimated the fitness to drive of 24 (35%) patients and underestimated the fitness to drive of 15 (22%) patients. Patients who incurred more traffic violations were more likely to be overestimated than underestimated by the physician (p = .03). Implications: This study showed disagreements between the fitness-to-drive recommendations made by the physicians and the on-road assessors in more than half of drivers with dementia. Efforts need to be made to improve the communication between physicians and on-road assessors for joint decision making of fitness to drive in dementia.

Longitudinal Executive Changes in Drivers with Parkinson's Disease: Study Using Neuropsychological and Driving Simulator Tasks.

BACKGROUND/AIMS: (1) To investigate how specific executive functions change over 2 years in drivers with Parkinson's disease (PD) compared to controls, using both neuropsychological and driving simulator tasks; and (2) to explore the association between the decline of specific executive functions and changes in driving habits in PD. METHODS: Sixteen PD patients and 21 controls underwent neuropsychological testing twice and performed tasks on a driving simulator, with an interval of approximately 2 years. Questions on participants' self-perception of their driving ability were administered. RESULTS: A significant decline was observed in shift cost over time (Plus Minus Test) in patients (p = 0.008). This decline was greater in patients than in controls (p = 0.008). No significant change emerged over time in the flexibility cost of PD patients on a simulator (p = 0.158). Significant correlations were found between the decline in shift cost over time and driving question outcomes (p < 0.05). CONCLUSION: This study reveals a differential course of executive functions in PD. Over time, patients displayed significant decline in flexibility associated with modifications in their driving. Flexibility seems to be affected as the disease progresses. This research opens new avenues in cognitive and driving rehabilitation.