Uc Ergun Y, Rizzo Matthew, Anderson Steven W, Sparks Jon David, Rodnitzky Robert L, Dawson Jeffrey D
Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, IA 52242, USA.
Brain. 2007 Sep;130(Pt 9):2433-40. doi: 10.1093/brain/awm178. Epub 2007 Aug 8.
Navigating a new route during automobile driving uses the driver's cognitive resources and has the potential to impair driving ability in people with Parkinson's disease (PD). Our aim was to assess navigation and safety errors during a route following task (RFT) in drivers with the illness. Seventy-seven subjects with mild-moderate PD (median Hoehn-Yahr stage = 2.0) and 152 neurologically normal elderly adults, all active and licensed drivers, were tested with a battery of visual, cognitive and motor tests of abilities. Each driver also performed a RFT administered on the road in an instrumented vehicle. Main outcome variables included: number of incorrect turns, times lost and at-fault safety errors. All group comparisons were adjusted for age, gender, education and familiarity with the region. Drivers with PD performed significantly worse on cognitive, visual and motor tests compared to controls, and took longer to finish the RFT. Higher proportions of these drivers made incorrect turns {53.9% in PD versus 21.1% in controls, Odds Ratio (OR) [95% Confidence Interval (CI)] = 2.8 [1.4, 5.7], P = 0.006}, got lost (15.8% versus 2.0%, OR [95%CI] = 4.7 [1.1, 20.0], P = 0.037), or committed at-fault safety errors (84.2% versus 46.7%, OR [95%CI] = 7.5 [3.3, 17.0], P < 0.001). Within the patient group, the navigational and safety errors were predicted by poor performances on cognitive and visual tests, but not by the severity of motor dysfunction. Drivers with PD made more navigation and safety errors than neurologically normal drivers on a RFT that placed demands on driver memory, attention, executive functions and visual perception. The PD group driver safety was degraded possibly due to an increase in the cognitive load in patients with limited reserves. Navigational errors and lower driver safety were associated more with impairments in cognitive and visual function than the motor severity of their disease in drivers with PD.
在汽车驾驶过程中导航新路线会消耗驾驶员的认知资源，并且有可能损害帕金森病（PD）患者的驾驶能力。我们的目的是评估患病驾驶员在路线跟踪任务（RFT）中的导航和安全错误。77名轻度至中度PD患者（Hoehn-Yahr分期中位数 = 2.0）和152名神经功能正常的老年人，均为活跃且有驾照的驾驶员，接受了一系列视觉、认知和运动能力测试。每位驾驶员还在一辆配备仪器的车辆上在道路上进行了RFT。主要结局变量包括：错误转弯次数、迷路时间和有责安全错误。所有组间比较均根据年龄、性别、教育程度和对该地区的熟悉程度进行了调整。与对照组相比，PD患者在认知、视觉和运动测试中的表现明显更差，完成RFT所需时间更长。这些患者中更高比例的人出现错误转弯（PD组为53.9%，对照组为21.1%，优势比（OR）[95%置信区间（CI）]= 2.8 [1.4, 5.7]，P = 0.006）、迷路（15.8%对2.0%，OR [95%CI]= 4.7 [1.1, 20.0]，P = 0.037）或出现有责安全错误（84.2%对46.7%，OR [95%CI]= 7.5 [3.3, 17.0]，P < 0.001）。在患者组中，导航和安全错误可通过认知和视觉测试的不佳表现预测，但不能通过运动功能障碍的严重程度预测。在一项对驾驶员记忆、注意力、执行功能和视觉感知有要求的RFT中，PD患者比神经功能正常的驾驶员出现更多的导航和安全错误。PD组驾驶员的安全性下降可能是由于储备有限的患者认知负荷增加所致。在PD患者中，导航错误和较低的驾驶员安全性与认知和视觉功能障碍的关联比与其疾病的运动严重程度更大。
