Cox D J, Quillian W C, Thorndike F P, Kovatchev B P, Hanna G
Department of Psychiatric Medicine, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
J Am Board Fam Pract. 1998 Jul-Aug;11(4):264-71. doi: 10.3122/jabfm.11.4.264.
Alzheimer disease (AD) is a progressive disease, with multiple physiologic, psychologic, and social implications. A critical issue in its management is when to recommend restrictions on autonomous functioning, such as driving an automobile. This study evaluates driving performance of patients with AD and its relation to patient scores on the Mini-Mental State Exam (MMSE).
This study compared 29 outpatients with probable AD with 21 age-matched control participants on an interactive driving simulator to determine how the two groups differed and how such differences related to mental status.
Patients with AD (1) were less likely to comprehend and operate the simulator cognitively, (2) drove off the road more often, (3) spent more time driving considerably slower than the posted speed limit, (4) spent less time driving faster than the speed limit, (5) applied less brake pressure in stop zones, (6) spent more time negotiating left turns, and (7) drove more poorly overall. There were no observed differences between AD patients and the control group in terms of crossing the midline and driving speed variability. Among the AD patients, those who could not drive the simulator because of confusion and disorientation (n = 10) had lower MMSE scores and drove fewer miles annually. Those AD patients who had stopped driving also scored lower on their MMSE but did not perform more poorly on the driving simulator. Factor analysis revealed five driving factors associated with AD, explaining 93 percent of the variance. These five factors correctly classified 27 (85 percent) of 32 AD patients compared with the control group. Of the 15 percent who were improperly classified, there were three false positives (control participants misclassified as AD patients) and two false negatives (AD patients misclassified as control participants). The computed total driving score correlated significantly with MMSE scores (r = -.403, P = 0.011).
Driving simulators can provide an objective means of assessing driving safety.
阿尔茨海默病（AD）是一种进行性疾病，具有多种生理、心理和社会影响。其管理中的一个关键问题是何时建议限制自主功能，如驾驶汽车。本研究评估了AD患者的驾驶表现及其与简易精神状态检查表（MMSE）患者评分的关系。
本研究在交互式驾驶模拟器上比较了29名可能患有AD的门诊患者和21名年龄匹配的对照参与者，以确定两组之间的差异以及这些差异与精神状态的关系。
AD患者（1）认知上理解和操作模拟器的可能性较小；（2）更频繁地偏离道路；（3）以比规定限速慢得多的速度驾驶的时间更多；（4）以高于限速的速度驾驶的时间更少；（5）在停车区施加的制动压力较小；（6）在左转弯时花费的时间更多；（7）总体驾驶表现更差。在越过中线和驾驶速度变异性方面，AD患者和对照组之间未观察到差异。在AD患者中，因困惑和定向障碍而无法驾驶模拟器的患者（n = 10）MMSE评分较低，且每年驾驶的里程数较少。那些已经停止驾驶的AD患者MMSE评分也较低，但在驾驶模拟器上的表现并没有更差。因子分析揭示了与AD相关的五个驾驶因素，解释了93%的方差。与对照组相比，这五个因素正确分类了32名AD患者中的27名（85%）。在15%分类错误的数据中，可以发现3例假阳性（对照参与者被误分类为AD患者）和2例假阴性（AD患者被误分类为对照参与者）。计算得出的总驾驶分数与MMSE分数显著相关（r = -0.403，P = 0.011）。
驾驶模拟器可以提供一种评估驾驶安全性的客观方法。
