Aksan Nazan, Anderson Steve W, Dawson Jeffrey, Uc Ergun, Rizzo Matthew
Department of Neurology, University of Iowa, Iowa City, IA, USA.
Department of Neurology, University of Iowa, Iowa City, IA, USA.
Accid Anal Prev. 2015 Feb;75:236-44. doi: 10.1016/j.aap.2014.12.007. Epub 2014 Dec 16.
The extent to which deficits in specific cognitive domains contribute to older drivers' safety risk in complex real-world driving tasks is not well understood. We selected 148 drivers older than 70 years of age both with and without neurodegenerative diseases (Alzheimer disease-AD and Parkinson disease-PD) from an existing driving database of older adults. Participant assessments included on-road driving safety and cognitive functioning in visuospatial construction, speed of processing, memory, and executive functioning. The standardized on-road drive test was designed to examine multiple facets of older driver safety including navigation performance (e.g., following a route, identifying landmarks), safety errors while concurrently performing secondary navigation tasks ("on-task" safety errors), and safety errors in the absence of any secondary navigation tasks ("baseline" safety errors). The inter-correlations of these outcome measures were fair to moderate supporting their distinctiveness. Participants with diseases performed worse than the healthy aging group on all driving measures and differences between those with AD and PD were minimal. In multivariate analyses, different domains of cognitive functioning predicted distinct facets of driver safety on road. Memory and set-shifting predicted performance in navigation-related secondary tasks, speed of processing predicted on-task safety errors, and visuospatial construction predicted baseline safety errors. These findings support broad assessments of cognitive functioning to inform decisions regarding older driver safety on the road and suggest navigation performance may be useful in evaluating older driver fitness and restrictions in licensing.
特定认知领域的缺陷在复杂的现实驾驶任务中对老年驾驶员安全风险的影响程度尚未得到充分了解。我们从一个现有的老年驾驶员数据库中挑选了148名70岁以上患有和未患有神经退行性疾病（阿尔茨海默病-AD和帕金森病-PD）的驾驶员。参与者评估包括道路驾驶安全性以及视觉空间构建、处理速度、记忆和执行功能方面的认知功能。标准化道路驾驶测试旨在检查老年驾驶员安全的多个方面，包括导航性能（例如，遵循路线、识别地标）、同时执行次要导航任务时的安全错误（“任务中”安全错误）以及在没有任何次要导航任务时的安全错误（“基线”安全错误）。这些结果指标之间的相互关联程度为中等，支持了它们的独特性。患病参与者在所有驾驶指标上的表现均比健康老龄化组差，且AD患者和PD患者之间的差异很小。在多变量分析中，不同的认知功能领域预测了道路上驾驶员安全的不同方面。记忆和任务转换预测了与导航相关的次要任务中的表现，处理速度预测了任务中安全错误，视觉空间构建预测了基线安全错误。这些发现支持对认知功能进行广泛评估，以为有关老年驾驶员道路安全的决策提供信息，并表明导航性能可能有助于评估老年驾驶员的健康状况和执照限制。
