Szlyk Janet P, Myers Lara, Zhang YuanXia, Wetzel Linda, Shapiro Rita
Department of Research and Development, VA Chicago Health Care System, West Side Division, 820 South Damen Avenue (M/C 151), Chicago, IL 60612, USA.
J Rehabil Res Dev. 2002 Jul-Aug;39(4):483-96.
This study was conducted to select a neuropsychological battery that correlated with driving simulator skills, thus enabling practitioners to provide information to older patients and their families about driving risks.
The study was conducted in two phases. In Phase 1, a survey inquiring as to the kinds of neuropsychological tests currently used to screen patients for driving was sent to 292 licensed neuropsychologists. Of these 292 surveys, 125 (43%) were returned. We used the responses to develop a battery of nine tests, including eight neuropsychological tests and one other cognitive measure: (1) the Seashore Rhythm Test, (2) Logical Memory (Immediate [I] and Delayed [II]) of the Wechsler Memory Scale-Revised (WMS-R), (3) WMS-R Visual Reproduction (Immediate [I] and Delayed [II]), (4) Trails A and B, (5) Digit Span, (6) Digit Symbol, (7) Block Design, (8) Visual Form Discrimination, and (9) a Zoo Map Test. The complete battery included 12 measures. In Phase 2, 22 licensed drivers were recruited ranging in age from 67 to 91 years (14 males and 8 females). The Mini-Mental Status Exam (MMSE) was administered to all subjects. Scores on this test served as a criterion cutoff for placement into a group of subjects with suspected dementia (Group 1, MMSE score below 25) or a group of control subjects (Group 2, with a MMSE score of 25 or above). None of the patients had any gross motor difficulties. Following screening, subjects were administered the neuropsychological battery, a driving simulator test, and a Driving Habits Interview.
Data revealed a significant difference between the performance of Groups 1 and 2 on the driving simulator test in two distinct areas, staying within one's lane boundaries and speed. The suspected dementia subjects had significantly more lane boundary crossings than the control subjects and drove at significantly slower speeds. Ten neuropsychological measures correlated with driving simulator performance. The number of lane boundary crossings correlated with the greatest number of neuropsychological tests, with more lane boundary crossings correlated with poorer performance on the neuropsychological tests. In particular, Trails A, Trails B, and Logical Memory (Immediate) correlated with the largest number of driving measures.
Preliminary findings show that commonly used neuropsychological tests correlated with driving simulator skills as measured with a driving simulator. Because the driving simulator has been shown to be correlated with actual on-road driving, one may hypothesize that these neuropsychological tests may be predictive of on-road driving. This research is important in defining an appropriate battery to screen for driving skills in patients with known or suspected dementia.
本研究旨在选择一套与驾驶模拟器技能相关的神经心理测试组合，从而使从业者能够向老年患者及其家属提供有关驾驶风险的信息。
该研究分两个阶段进行。在第一阶段，向292名有执照的神经心理学家发送了一项关于当前用于筛查患者驾驶能力的神经心理测试种类的调查问卷。在这292份调查问卷中，有125份（43%）被收回。我们根据这些回复制定了一套包含九项测试的组合，其中包括八项神经心理测试和一项其他认知测量：（1）海滨节奏测试，（2）韦氏记忆量表修订版（WMS-R）的逻辑记忆（即时[I]和延迟[II]），（3）WMS-R视觉再现（即时[I]和延迟[II]），（4）连线测验A和B，（5）数字广度，（6）数字符号，（7）积木图案，（8）视觉形状辨别，以及（9）动物园地图测试。完整的测试组合包括12项测量。在第二阶段，招募了22名有执照的驾驶员，年龄在67岁至91岁之间（14名男性和8名女性）。对所有受试者进行简易精神状态检查表（MMSE）测试。该测试的分数作为一个标准临界值，用于将受试者分为疑似痴呆组（第1组，MMSE分数低于25）或对照组（第2组，MMSE分数为25或以上）。所有患者均无明显的运动困难。筛查后，对受试者进行神经心理测试组合、驾驶模拟器测试和驾驶习惯访谈。
数据显示，第1组和第2组在驾驶模拟器测试中的表现在两个不同方面存在显著差异，即保持在自己的车道边界内和速度方面。疑似痴呆的受试者比对照组有更多的车道边界穿越情况，并且驾驶速度明显更慢。十项神经心理测量与驾驶模拟器表现相关。车道边界穿越的次数与最多数量的神经心理测试相关，车道边界穿越次数越多，神经心理测试的表现越差。特别是，连线测验A、连线测验B和逻辑记忆（即时）与最多数量的驾驶测量相关。
初步研究结果表明，常用的神经心理测试与通过驾驶模拟器测量的驾驶模拟器技能相关。由于驾驶模拟器已被证明与实际道路驾驶相关，因此可以推测这些神经心理测试可能对道路驾驶具有预测性。这项研究对于确定一套合适的测试组合以筛查已知或疑似痴呆患者的驾驶技能具有重要意义。
