From the Department of Physical Therapy (H.D.), College of Allied Health Sciences, Georgia Regents University, Augusta, GA; Department of Rehabilitation Sciences (H.D., A.N., W.D.W.), KU Leuven, Heverlee; Department of Neurology (W.V.), University Hospitals Leuven; Department of Neurosciences (W.V.), KU Leuven, Leuven; CARA Department (M.T.), Belgian Road Safety Institute, Brussels, Belgium; Department of Neurology (E.Y.U.), University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Veterans Affairs Medical Center, Iowa City, IA.
Neurology. 2014 Mar 18;82(11):956-62. doi: 10.1212/WNL.0000000000000220. Epub 2014 Feb 12.
To determine the driving skill impairments and underlying visual, motor, and cognitive deficits that lead to failure on road testing in manifest Huntington disease (HD).
Certified driving assessment experts scored performance on 13 specific on-road driving skills in 30 persons with HD and 30 controls and issued a pass/fail decision based on their overall impression. These on-road skill items were mapped onto an existing theoretical framework that categorized driving skills into operational, tactical, visuo-integrative, and mixed clusters. The HD group additionally completed a detailed off-road battery of motor, visual, and neuropsychological tests.
The HD group performed worse on all on-road items. Fourteen drivers with HD (47%) failed the road test compared with none of the controls. Scores on the Total Functional Capacity scale discriminated significantly between pass and fail groups. Total on-road score and performance in operational, tactical, and visuo-integrative clusters correlated strongly (Spearman ρ >0.50) with the pass/fail decision. The off-road tests showed variable strengths of association depending on the level of driving skill. Selective attention was strongly associated (Spearman ρ >0.50) with the total on-road score and all driving clusters.
HD affects driving at many levels due to motor and cognitive deficits and leads to unsafe road performance even in mild stages. The high failure rate on the road test and difficulties in all aspects of on-road driving suggest that monitoring of fitness to drive should be initiated in the early course of HD.
确定导致明显亨廷顿病（HD）患者路考失败的驾驶技能障碍和潜在的视觉、运动及认知缺陷。
经认证的驾驶评估专家对 30 名 HD 患者和 30 名对照者的 13 项特定道路驾驶技能进行评分，并根据他们的整体印象做出通过/不通过的决定。这些道路技能项目与现有的理论框架相匹配，该框架将驾驶技能分为操作、战术、视整合和混合集群。HD 组还完成了详细的运动、视觉和神经心理学的越野测试。
HD 组在所有道路项目上的表现都更差。14 名（47%）HD 患者未能通过路考，而对照组则无人失败。总功能能力量表的评分在通过和失败组之间有显著差异。总道路得分和操作、战术和视整合集群的表现与通过/失败的决定有很强的相关性（Spearman ρ>0.50）。越野测试显示出与驾驶技能水平有关的不同关联强度。选择性注意力与总道路得分和所有驾驶集群有很强的相关性（Spearman ρ>0.50）。
HD 由于运动和认知缺陷而在多个层面上影响驾驶，即使在轻度阶段也会导致不安全的道路表现。道路测试的高失败率以及在道路驾驶的各个方面的困难表明，在 HD 的早期阶段就应开始监测驾驶能力。
