Carr D B, Duchek J, Morris J C
Department of Medicine, Washington University, St. Louis, Missouri 63108, USA.
J Am Geriatr Soc. 2000 Jan;48(1):18-22. doi: 10.1111/j.1532-5415.2000.tb03023.x.
To determine whether there is a difference in crash rates and characteristics between drivers with dementia of the Alzheimer type (DAT) and nondemented older persons who were controls.
A pilot study using a 5-year retrospective analysis of state-recorded crash data and crash characteristics followed by patient enrollment into a study on road test skills.
Alzheimer's Disease Research Center at Washington University in St. Louis, Missouri. Subjects were enrolled as volunteers in a longitudinal study of aging and DAT.
One hundred twenty-one subjects (58 nondemented, older drivers and 63 drivers with DAT) with a mean age of 77 years met the inclusion criteria for this study. DAT was diagnosed using validated clinical diagnostic criteria and was staged by the Clinical Dementia Rating (CDR) Scale. All subjects with DAT were in the very mild (CDR = 0.5) or mild (CDR = 1) stages.
State-recorded traffic crashes. Also, a daily driving diary was completed by each subject and used to estimate miles traveled per year.
Subjects diagnosed with mild DAT (CDR = 1) reported less roadway exposure (average number of miles driven per year) than did drivers with very mild DAT (CDR = 0.5) or controls. Crashes in both groups were infrequent, with 0.07 state-recorded crashes per driver per year in the nondemented group (CDR = 0), 0.06 in the very mild DAT group (CDR = 0.5), and 0.04 in the mild DAT group (CDR = 1). There was no statistical difference in the crash frequency between groups, even when adjusting for exposure. Drivers with DAT had trends toward more at-fault crashes, crashes with injuries, and crashes in which the officer on the scene cited failure to yield.
In our sample, individuals with very mild or mild DAT who continued to drive seemed to have crash rates similar to those of the controls. There may be significant differences between the causes and the consequences of crashes involving drivers with DAT when compared with cognitively intact age-matched controls, but none were found in this pilot study. Further research on crash characteristics is needed in larger samples of community-based drivers with DAT across wider ranges of dementia severity to address issues such as driving competency and public safety.
确定患有阿尔茨海默型痴呆（DAT）的驾驶员与作为对照的无痴呆老年人在撞车率及撞车特征方面是否存在差异。
一项试点研究，对州记录的撞车数据和撞车特征进行为期5年的回顾性分析，随后让患者参加一项道路测试技能研究。
密苏里州圣路易斯市华盛顿大学阿尔茨海默病研究中心。受试者作为衰老和DAT纵向研究的志愿者入组。
121名平均年龄为77岁的受试者（58名无痴呆的老年驾驶员和63名患有DAT的驾驶员）符合本研究的纳入标准。DAT采用经过验证的临床诊断标准进行诊断，并通过临床痴呆评定量表（CDR）进行分期。所有患有DAT的受试者均处于极轻度（CDR = 0.5）或轻度（CDR = 1）阶段。
州记录的交通撞车事故。此外，每位受试者填写一份每日驾驶日记，用于估算每年行驶的里程数。
被诊断为轻度DAT（CDR = 1）的受试者报告的道路暴露情况（每年平均驾驶里程数）少于极轻度DAT（CDR = 0.5）的驾驶员或对照组。两组的撞车事故都很少见，无痴呆组（CDR = 0）每位驾驶员每年有0.07次州记录的撞车事故，极轻度DAT组（CDR = 0.5）为0.06次，轻度DAT组（CDR = 1）为0.04次。即使对暴露情况进行调整，两组之间的撞车频率也没有统计学差异。患有DAT的驾驶员在过失撞车、有人员受伤的撞车以及现场警官认定为未让行的撞车方面有增多的趋势。
在我们的样本中，继续开车的极轻度或轻度DAT个体的撞车率似乎与对照组相似。与认知功能正常的年龄匹配对照组相比，涉及患有DAT的驾驶员的撞车原因和后果可能存在显著差异，但在这项试点研究中未发现。需要在更大样本的社区中不同痴呆严重程度范围的患有DAT的驾驶员中，对撞车特征进行进一步研究，以解决驾驶能力和公共安全等问题。
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