Uc Ergun Y, Rizzo Matthew, O'Shea Amy M J, Anderson Steven W, Dawson Jeffrey D
From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha.
Neurology. 2017 Nov 7;89(19):1951-1958. doi: 10.1212/WNL.0000000000004629. Epub 2017 Oct 11.
To longitudinally assess and predict on-road driving safety in Parkinson disease (PD).
Drivers with PD (n = 67) and healthy controls (n = 110) drove a standardized route in an instrumented vehicle and were invited to return 2 years later. A professional driving expert reviewed drive data and videos to score safety errors.
At baseline, drivers with PD performed worse on visual, cognitive, and motor tests, and committed more road safety errors compared to controls (median PD 38.0 vs controls 30.5; < 0.001). A smaller proportion of drivers with PD returned for repeat testing (42.8% vs 62.7%; < 0.01). At baseline, returnees with PD made fewer errors than nonreturnees with PD (median 34.5 vs 40.0; < 0.05) and performed similar to control returnees (median 33). Baseline global cognitive performance of returnees with PD was better than that of nonreturnees with PD, but worse than for control returnees ( < 0.05). After 2 years, returnees with PD showed greater cognitive decline and larger increase in error counts than control returnees (median increase PD 13.5 vs controls 3.0; < 0.001). Driving error count increase in the returnees with PD was predicted by greater error count and worse visual acuity at baseline, and by greater interval worsening of global cognition, Unified Parkinson's Disease Rating Scale activities of daily living score, executive functions, visual processing speed, and attention.
Despite drop out of the more impaired drivers within the PD cohort, returning drivers with PD, who drove like controls without PD at baseline, showed many more driving safety errors than controls after 2 years. Driving decline in PD was predicted by baseline driving performance and deterioration of cognitive, visual, and functional abnormalities on follow-up.
纵向评估和预测帕金森病（PD）患者的道路驾驶安全性。
PD患者（n = 67）和健康对照者（n = 110）驾驶一辆装备仪器的车辆行驶标准化路线，并被邀请在2年后返回。一名专业驾驶专家审查驾驶数据和视频，对安全错误进行评分。
在基线时，与对照组相比，PD患者在视觉、认知和运动测试中表现更差，道路安全错误更多（PD组中位数为38.0，对照组为30.5；<0.001）。PD患者返回进行重复测试的比例较小（42.8%对62.7%；<0.01）。在基线时，PD组返回者的错误比未返回者少（中位数为34.5对40.0；<0.05），且与对照组返回者表现相似（中位数为33）。PD组返回者的基线整体认知表现优于未返回者，但比对照组返回者差（<0.05）。2年后，与对照组返回者相比，PD组返回者的认知衰退更大，错误计数增加更多（PD组中位数增加13.5，对照组为3.0；<0.001）。PD组返回者驾驶错误计数的增加可通过基线时更高的错误计数、更差的视力，以及整体认知、统一帕金森病评定量表日常生活活动评分、执行功能、视觉处理速度和注意力的更大间隔恶化来预测。
尽管PD队列中受损更严重的驾驶者退出了研究，但在基线时驾驶表现与无PD的对照组相似的返回PD患者，在2年后的驾驶安全错误比对照组多得多。PD患者的驾驶能力下降可通过基线驾驶表现以及随访时认知、视觉和功能异常的恶化来预测。
