1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece.
Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece.
Mov Disord Clin Pract. 2024 Mar;11(3):198-208. doi: 10.1002/mdc3.13942. Epub 2024 Jan 1.
Motor/nonmotor symptomatology and antiparkinsonian drugs deteriorate the driving ability of Parkinson's disease (PD) patients.
Treating neurologists are frequently asked to evaluate driving fitness of their patients and provide evidence-based consultation. Although several guidelines have been published, the exact procedure along with the neurologist's role in this procedure remains obscure.
We systematically reviewed the existing guidelines, regarding driving fitness evaluation of PD patients. We searched MEDLINE and Google Scholar and identified 109 articles. After specified inclusion criteria were applied, 15 articles were included (nine national guidelines, five recommendation papers, and one consensus statement).
The treating physician is proposed as the initial evaluator in 8 of 15 articles (neurologist in 2 articles) and may refer patients for a second-line evaluation. The evaluation should include motor, cognitive, and visual assessment (proposed in 15, 13, and 8 articles, respectively). Specific motor tests are proposed in eight articles (cutoff values in four), whereas specific neuropsychological and visual tests are proposed in seven articles each (cutoff values in four and three articles, respectively). Conditional licenses are proposed in 11 of 15 articles, to facilitate driving for PD patients. We summarized our findings on a graphic of the procedure for driving fitness evaluation of PD patients.
Neurological aspects of driving fitness evaluation of PD patients are recognized in most of the guidelines. Motor, neuropsychological, visual, and sleep assessment and medication review are key components. Clear-cut instructions regarding motor, neuropsychological, and visual tests and relative cutoff values are lacking. Conditional licenses and periodical reevaluation of driving fitness are important safety measures.
运动/非运动症状和抗帕金森病药物会降低帕金森病（PD）患者的驾驶能力。
治疗神经科医生经常被要求评估其患者的驾驶能力并提供基于证据的咨询。尽管已经发布了几项指南，但确切的程序以及神经科医生在该程序中的作用仍不清楚。
我们系统地回顾了现有的关于 PD 患者驾驶能力评估的指南。我们在 MEDLINE 和 Google Scholar 上进行了搜索，共确定了 109 篇文章。在应用特定的纳入标准后，共纳入了 15 篇文章（9 项国家指南、5 篇推荐文章和 1 项共识声明）。
在 15 篇文章中的 8 篇（2 篇为神经科医生）中，建议治疗医生作为初始评估者，并可能将患者转介进行二线评估。评估应包括运动、认知和视觉评估（分别在 15、13 和 8 篇文章中提出）。在 8 篇文章中提出了具体的运动测试（4 篇文章中提出了截止值），而在 7 篇文章中分别提出了具体的神经心理学和视觉测试（4 篇和 3 篇文章中分别提出了截止值）。在 15 篇文章中的 11 篇中提出了有条件的驾照，以方便 PD 患者驾驶。我们将我们的发现总结在 PD 患者驾驶能力评估程序的图表上。
大多数指南都认识到 PD 患者驾驶能力评估的神经学方面。运动、神经心理学、视觉和睡眠评估以及药物审查是关键组成部分。缺乏关于运动、神经心理学和视觉测试及相对截止值的明确说明。有条件的驾照和定期重新评估驾驶能力是重要的安全措施。
