Estevis Eduardo, Noll Kyle R, Bradshaw Mariana E, Wefel Jeffrey S
Neuroscience Institute, DHR Health, Edinburg, Texas.
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston.
Neurooncol Pract. 2019 Dec;6(6):490-498. doi: 10.1093/nop/npz014. Epub 2019 Apr 11.
Operating a motor vehicle involves multiple cognitive and sensorimotor faculties. Neurological conditions pose driving risk, but this has not been examined in patients with primary brain tumors.
Sixty-four patients with primary brain tumors (32 left hemisphere; 69% glioblastoma) completed the Cognitive Behavioral Driver's Inventory (CBDI). A subset also completed broader cognitive testing. Patient characteristics, CBDI measures, and broader neuropsychological test scores were compared between Passing and Nonpassing groups. Follow-up logistic regression analyses identified patient characteristics and CBDI measures predictive of Pass/Nonpass outcome. Point-biserial correlations determined associations between neuropsychological tests and CBDI outcome.
Sixty-nine percent of patients were classified as passing the CBDI. Nonpassing patients were older and more likely to have WHO grade IV and temporal lobe tumors. Age was the most salient predictor of CBDI performance. CBDI measures of speeded visual search and set-shifting, speeded response inhibition, vigilance and freedom from distractibility, and basic visual scanning speed were predictive of Pass/Nonpass outcome. Neuropsychological tests of memory in particular, but also speeded visual scanning and discrimination, executive function, basic visual attention, visuoconstruction, and manual dexterity (dominant hand), were associated with CBDI outcome.
A sizeable proportion of patients with primary brain tumors appear at risk of driving difficulty, particularly those with higher-grade tumors and of older age. Memory, visual attention, and executive difficulties appear to contribute most to driving safety risk as determined by the CBDI. These results highlight the importance of driving safety screening in this population.
驾驶机动车涉及多种认知和感觉运动能力。神经系统疾病会带来驾驶风险，但原发性脑肿瘤患者的这一情况尚未得到研究。
64例原发性脑肿瘤患者（32例左半球；69%为胶质母细胞瘤）完成了认知行为驾驶能力量表（CBDI）测试。其中一部分患者还完成了更广泛的认知测试。比较了通过组和未通过组患者的特征、CBDI测量结果以及更广泛的神经心理学测试分数。后续的逻辑回归分析确定了预测通过/未通过结果的患者特征和CBDI测量指标。点二列相关分析确定了神经心理学测试与CBDI结果之间的关联。
69%的患者被归类为通过CBDI测试。未通过测试的患者年龄更大，更有可能患有世界卫生组织IV级肿瘤和颞叶肿瘤。年龄是CBDI表现的最显著预测因素。CBDI中快速视觉搜索和任务转换、快速反应抑制、警觉性和抗分心能力以及基本视觉扫描速度的测量指标可预测通过/未通过结果。特别是记忆方面的神经心理学测试，以及快速视觉扫描和辨别、执行功能、基本视觉注意力、视觉构建和手部灵活性（优势手）与CBDI结果相关。
相当一部分原发性脑肿瘤患者似乎存在驾驶困难的风险，尤其是那些肿瘤分级较高和年龄较大的患者。记忆、视觉注意力和执行功能方面的困难似乎是导致CBDI确定的驾驶安全风险的主要因素。这些结果凸显了对这一人群进行驾驶安全筛查的重要性。
