Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease.
Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I-III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0-1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe. Overall, Alzheimer's patients were more impaired drivers than Parkinson's patients. Parkinson's patients distinguished themselves from other drivers by a head-turning deficiency. Drivers with neuropsychological impairment were more likely to be unsafe drivers in both disease groups compared to controls. Compared to controls, unsafe drivers with Alzheimer's disease were impaired across all neuropsychological measures except finger tapping. Driving performance in Parkinson's patients was related to disease severity (H&Y), neuropsychological measures [Rey Osterreith Complex Figure (ROCF), Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and specific motor symptoms (axial rigidity, postural instability), but not to the Unified Parkinson Disease Rating Scale (UPDRS) motor score. Multifactorial measures (ROCF, Trails B) were useful in distinguishing safe from unsafe drivers in both patient groups.
Grace
Janet
J
Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA. Janet_Grace@mhri.org
Amick
Melissa M
MM
D'Abreu
Anelyssa
A
Festa
Elena K
EK
Heindel
William C
WC
Ott
Brian R
BR
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000503:physiopathology*; D000704:Analysis of Variance; D001333:Automobile Driver Examination / Q000706:statistics & numerical data; D001334:Automobile Driving; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D018782:Maze Learning / Q000502:physiology; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011597:Psychomotor Performance / Q000502:physiology*; D014706:Verbal Learning / Q000502:physiology