Institute of Hygiene and Preventive Medicine, Catholic University of Sacred Heart, Rome, Italy.
Accid Anal Prev. 2013 Jan;50:377-96. doi: 10.1016/j.aap.2012.05.010. Epub 2012 May 31.
When an health condition has been identified, the question of whether to continue driving depends not on a medical diagnosis, but on the functional consequences of the illness. The complex nature of physical and mental impairments and their relationship with safe driving make the availability of evidence based tools necessary for health professionals. The review aims at identifying and summarizing scientific findings concerning the relationship between neuropsychological and clinical screening tests and fitness to drive among people with chronic conditions. Studies were searched for driving ability evaluation by road test or simulator, clinical/neuropsychological examinations of participants with chronic diseases or permanent disablement impairing driving performance, primary outcomes as fatal/non-fatal traffic injuries and secondary outcomes as fitness to drive assessment. Twenty-seven studies fulfilled the inclusion criteria. Some studies included more than one clinical condition. The illness investigated were Alzheimer Disease (n=6), Parkinson Disease (n=8), Cardiovascular Accident (n=4), Traumatic Brain Injuries (n=3), Sleep Apnea Syndrome (n=2), Narcolepsy (n=1), Multiple Sclerosis (n=1) and Hepatic Encephalopathy (n=1), comorbidities (n=3). No studies match inclusion criteria about Myasthenia Gravis, Diabetes Mellitus, Renal Diseases, Hearing Disorders and Sight Diseases. No studies referred to primary outcomes. The selected studies provided opposite evidences. It would be reasonable to argue that some clinical and neuropsychological tests are effective in predicting fitness to drive even if contrasting results support that driving performance decreases as a function of clinical and neuropsychological decline in some chronic diseases. Nevertheless we found no evidence that clinical and neuropsychological screening tests would lead to a reduction in motor vehicle crashes involving chronic disabled drivers. It seems necessary to develop tests with proven validity for identifying high-risk drivers so that physicians can provide guidance to their patients in chronic conditions, and also to medical advisory boards working with licensing offices.
当确定了一种健康状况后，是否继续驾驶的问题取决于疾病的功能后果，而不是医学诊断。身体和精神损伤的复杂性及其与安全驾驶的关系使得健康专业人员需要使用基于证据的工具。本综述旨在确定和总结与慢性疾病患者的驾驶能力相关的神经心理学和临床筛查测试与适合驾驶之间的关系的科学发现。研究通过路考或模拟器评估驾驶能力，对患有慢性疾病或永久性残疾影响驾驶表现的参与者进行临床/神经心理学检查，主要结局为致命/非致命交通伤害，次要结局为驾驶能力评估。有 27 项研究符合纳入标准。一些研究包括一种以上的临床病症。研究的疾病包括阿尔茨海默病（n=6）、帕金森病（n=8）、心血管意外（n=4）、创伤性脑损伤（n=3）、睡眠呼吸暂停综合征（n=2）、发作性睡病（n=1）、多发性硬化症（n=1）和肝性脑病（n=1），合并症（n=3）。没有研究符合纳入标准，涉及重症肌无力、糖尿病、肾脏疾病、听力障碍和视力障碍。没有研究提到主要结局。入选的研究提供了相反的证据。有理由认为，一些临床和神经心理学测试可以有效地预测适合驾驶的能力，即使一些慢性疾病的临床和神经心理学下降会导致驾驶表现下降的对比结果支持这一观点。然而，我们没有发现证据表明临床和神经心理学筛查测试会导致慢性残疾驾驶员的机动车事故减少。似乎有必要开发经过验证的有效性测试，以识别高风险驾驶员，以便医生可以为慢性疾病患者提供指导，并为与许可办公室合作的医学咨询委员会提供指导。
