孤立型和症状型 REM 睡眠行为障碍患者的认知功能和驾驶能力。
Cognition and driving ability in isolated and symptomatic REM sleep behavior disorder.
机构信息
Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA.
Mayo Center for Sleep Medicine, Rochester, MN, USA.
出版信息
Sleep. 2022 Apr 11;45(4). doi: 10.1093/sleep/zsab253.
STUDY OBJECTIVES
To analyze cognitive deficits leading to unsafe driving in patients with REM Sleep Behavior Disorder (RBD), strongly associated with cognitive impairment and synucleinopathy-related neurodegeneration.
METHODS
Twenty isolated RBD (iRBD), 10 symptomatic RBD (sRBD), and 20 age- and education-matched controls participated in a prospective case-control driving simulation study. Group mean differences were compared with correlations between cognitive and driving safety measures.
RESULTS
iRBD and sRBD patients were more cognitively impaired than controls in global neurocognitive functioning, processing speeds, visuospatial attention, and distractibility (p < .05). sRBD patients drove slower with more collisions than iRBD patients and controls (p < .05), required more warnings, and had greater difficulty following and matching speed of a lead car during simulated car-following tasks (p < .05). Driving safety measures were similar between iRBD patients and controls. Slower psychomotor speed correlated with more off-road accidents (r = 0.65) while processing speed (-0.88), executive function (-0.90), and visuospatial impairment (0.74) correlated with safety warnings in sRBD patients. Slower stimulus recognition was associated with more signal-light (0.64) and stop-sign (0.56) infractions in iRBD patients.
CONCLUSIONS
iRBD and sRBD patients have greater selective cognitive impairments than controls, particularly visuospatial abilities and processing speed. sRBD patients exhibited unsafe driving behaviors, associated with processing speed, visuospatial awareness, and attentional impairments. Our results suggest that iRBD patients have similar driving-simulator performance as healthy controls but that driving capabilities regress as RBD progresses to symptomatic RBD with overt signs of cognitive, autonomic, and motor impairment. Longitudinal studies with serial driving simulator evaluations and objective on-road driving performance are needed.
研究目的
分析 REM 睡眠行为障碍（RBD）患者导致不安全驾驶的认知缺陷，这些缺陷与认知障碍和与突触核蛋白病相关的神经退行性变密切相关。
方法
20 名孤立性 RBD（iRBD）患者、10 名有症状的 RBD（sRBD）患者和 20 名年龄和教育程度匹配的对照组参加了一项前瞻性病例对照驾驶模拟研究。比较了组间差异与认知和驾驶安全措施之间的相关性。
结果
与对照组相比，iRBD 和 sRBD 患者在整体神经认知功能、处理速度、视空间注意力和注意力分散方面认知受损更严重（p<0.05）。与 iRBD 患者和对照组相比，sRBD 患者的驾驶速度较慢，碰撞更多（p<0.05），需要更多的警告，并且在模拟跟车任务中，跟随和匹配前车速度的难度更大（p<0.05）。iRBD 患者与对照组的驾驶安全措施相似。较慢的精神运动速度与更多的偏离道路事故相关（r=0.65），而处理速度（-0.88）、执行功能（-0.90）和视空间损害（0.74）与 sRBD 患者的安全警告相关。较慢的刺激识别与更多的信号灯（0.64）和停车信号（0.56）违规有关。
结论
iRBD 和 sRBD 患者的认知缺陷比对照组更为严重，特别是视空间能力和处理速度。sRBD 患者表现出不安全的驾驶行为，与处理速度、视空间意识和注意力损伤有关。我们的研究结果表明，iRBD 患者在驾驶模拟器性能上与健康对照组相似，但随着 RBD 进展为有明显认知、自主和运动障碍的有症状 RBD，驾驶能力会下降。需要进行纵向研究，进行连续的驾驶模拟器评估和客观的道路驾驶性能评估。
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