Rizzo M, Reinach S, McGehee D, Dawson J
Colleges of Medicine, University of Iowa, Iowa City, USA.
Arch Neurol. 1997 May;54(5):545-51. doi: 10.1001/archneur.1997.00550170027011.
Alzheimer disease (AD) is the most common cause of dementia and can impair cognitive abilities crucial to the task of driving. Rational decisions about whether such impaired individuals should continue to drive require objective assessments of driver performance.
To measure relevant performance factors using high-fidelity driving simulation.
We examined the effect of AD on driver collision avoidance using the Iowa Driving Simulator, which provided a high-fidelity, closely controlled environment in which to observe serious errors by at-risk drivers. We determined how such unsafe events are predicted by visual and cognitive factors sensitive to decline in aging and AD.
The University of Iowa Hospitals and Clinics, Iowa City, and the Iowa Driving Simulator.
Thirty-nine licensed drivers: 21 with AD and 18 controls without dementia.
We determined the number of crashes and related performance errors and analyzed how these occurrences were predicted by visual and cognitive factors.
Six participants (29%) with AD experienced crashes vs 0 of 18 control participants (P = .022). Drivers with AD were more than twice as likely to experience close calls (P = .042). Plots of critical control factors in the moments preceding a crash revealed patterns of driver in-attention and error. Strong predictors of crashes included visuospatial impairment, reduction in the useful field of view, and reduced perception of 3-dimensional structure-from-motion.
High-fidelity driving simulation provides a unique new source of performance parameters to standardize the assessment of driver fitness. Detailed observations of crashes and other safety errors provide unbiased evidence to aid in the difficult clinical decision of whether older or medically impaired individuals should continue to drive. The findings are complementary to evidence currently being gathered using techniques from epidemiology and cognitive neuroscience.
阿尔茨海默病（AD）是痴呆症最常见的病因，会损害驾驶任务中至关重要的认知能力。对于此类认知受损个体是否应继续驾驶做出合理决策，需要对驾驶表现进行客观评估。
使用高保真驾驶模拟来测量相关表现因素。
我们使用爱荷华驾驶模拟器研究AD对驾驶员避免碰撞的影响，该模拟器提供了一个高保真、严格控制的环境，用于观察高危驾驶员的严重错误。我们确定了视觉和认知因素如何预测此类不安全事件，这些因素对衰老和AD导致的功能衰退敏感。
爱荷华大学医院及诊所、爱荷华市以及爱荷华驾驶模拟器。
39名持证驾驶员，其中21名患有AD，18名无痴呆症的对照者。
我们确定了碰撞次数和相关的操作错误，并分析了视觉和认知因素如何预测这些事件的发生。
6名（29%）患有AD的参与者发生了碰撞，而18名对照参与者中无人发生碰撞（P = 0.022）。患有AD的驾驶员发生险些碰撞的可能性是对照者的两倍多（P = 0.042）。碰撞前关键时刻关键控制因素的图表显示了驾驶员注意力不集中和失误的模式。碰撞的强预测因素包括视觉空间障碍、有用视野缩小以及对三维运动结构感知的降低。
高保真驾驶模拟为标准化驾驶员健康评估提供了一个独特的新的表现参数来源。对碰撞和其他安全错误的详细观察提供了无偏见的证据，有助于辅助做出关于老年人或有医学损伤的个体是否应继续驾驶这一艰难的临床决策。这些发现与目前使用流行病学和认知神经科学技术收集的证据相辅相成。
