Driving Cessation and Self-Reported Car Crashes in Older Drivers: The Impact of Cognitive Impairment and Dementia in a Population-Based Study

Lafont, Sylviane; Laumon, Bernard; Helmer, Catherine; Dartigues, Jean‐François; Fabrigoule, Colette

doi:10.1177/0891988708316861

Cited by 73 publications

(51 citation statements)

References 63 publications

(123 reference statements)

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“…Driving outcomes, especially cessation, in the PD group were associated with demographic factors, severity of parkinsonism, performance on cognitive, visual, motor, and road tests, as well as driving record, exposure, and habits, suggesting need for a multidimensional approach to evaluate drivers with PD. Our results are consistent with prior reports that PD is associated with increased driving cessation 20 and no clear link could be established with PD and occurrence of real-life crashes. 27,28 However, these prior studies concentrated on general elderly population and had few drivers with PD in their cohorts.…”

Section: Discussionsupporting

confidence: 88%

Real-life driving outcomes in Parkinson disease

Uç¹,

Rizzo

Johnson³

et al. 2011

Neurology

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Objective: To determine the incidence of and risk factors for driving outcomes in drivers with Parkinson disease (PD). Methods:In a prospective cohort study, we ascertained the time until driving cessation, a crash, or a traffic citation using self-report and state Department of Transportation records in 106 licensed, active drivers with PD and 130 controls.Results: Drivers with PD stopped driving earlier than controls, hazard ratio (95% confidence interval) ϭ 7.09 (3.66-13.75), p Ͻ 0.001. Cumulative incidence of driving cessation at 2 years after baseline was 17.6% (11.5%-26.5%) for PD and 3.1% (1.2%-8.1%) for controls. No significant differences between groups on times to first crash or citation were detected. However, the number of observed crashes was low. Cox proportional hazards models showed that significant baseline risk factors for driving cessation in PD were older age, preference to be driven by somebody else, positive crash history, use of compensatory strategies, low driving exposure, impairments in visual perception (especially visual processing speed and attention) and cognitive abilities, parkinsonism (especially activities of daily living score and total daily dose of antiparkinsonian medications), and higher error counts on a road test. Within PD, crashes were associated with poorer postural stability and history of driving citations, and citations were associated with younger age and road errors at baseline. Conclusions:Drivers with PD are at a higher risk of driving cessation than elderly control drivers. A battery evaluating motor and nonmotor aspects of PD, driving record, and performance can be useful in assessing future driving outcomes in PD. Neurology Cognitive, visual, and motor impairments in Parkinson disease (PD) can affect driving performance on standardized road tests 1-11 and driving simulator experiments. 12-16 Cross-sectional or retrospective surveys show higher rates of driving cessation in PD, 17-21 which may lead to greater inactivity, social isolation, depression, and caregiver burden. 22,23 Driving simulation studies have shown increased crash rates in PD 13,16 and retrospective surveys have suggested increased crashes in drivers with PD. 17,19 However, real-life driving outcomes in PD have not been determined in prospective, controlled PD cohort studies. 21This study examines the real-life outcomes in a PD driver cohort, whose baseline features, experimental road test, and driving simulator performance were reported previously. 1,5,6,8,16 The main outcome measures in this study were time to driving cessation, time to first crash, and time to first citation. We hypothesized that the incidence of unfavorable real-life driving outcomes in drivers with PD would be higher than in neurologically normal control drivers,

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Section: Discussionsupporting

confidence: 88%

Real-life driving outcomes in Parkinson disease

Uç¹,

Rizzo

Johnson³

et al. 2011

Neurology

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“…When they are involved in a crash, the probability that they will die or be seriously injured is much higher than that of younger drivers [12][13][14][15][16][17] . Concerning the effect of DAT on crash risk, certain studies have found a higher crash risk [18][19][20][21][22][23][24] , while others have not [25][26][27] . A higher crash risk is probably not found systematically because people suffering from DAT often limit or even stop driving altogether [19,26,28] , these restrictions increasing with the severity of the disease [29][30][31] .…”

Section: Introductionmentioning

confidence: 99%

The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging

Lafont

Marin-Lamellet

Paire‐Ficout

et al. 2010

Dement Geriatr Cogn Disord

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Aims: Our purpose was to identify cognitive tools associated with unsafe driving among elderly drivers of varying cognitive levels. Methods: Twenty drivers with early-stage dementia of the Alzheimer type and 56 nondemented drivers aged 65–85 were recruited. Various cognitive processes were measured and unsafe driving was evaluated during an in-traffic road test with 3 different indicators and a composite indicator. Results: The Wechsler Digit Symbol Substitution Test score was the best cognitive measure to detect unsafe drivers using the composite driving indicator. Conclusion: The Digit Symbol Substitution Test may be used by physicians for the evaluation and follow-up of older patients, with or without Alzheimer-type dementia, as a screening tool of unsafe driving.

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“…However, these studies have methodological bias or limitations such as small sample or lack of control group. Conversely, a cross-sectional study including a population-based sample of 1051 drivers aged 65 years or more [25] showed that PD patients did not report more crashes than drivers without neurological diseases. Nevertheless, the sample size for PD was small.…”

Section: Introductionmentioning

confidence: 99%

Relationships between Cognitive Functions and Driving Behavior in Parkinson’s Disease

Ranchet¹,

Broussolle²,

Poisson³

et al. 2012

Eur Neurol

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Alterations in cognitive functions in Parkinson’s disease (PD) have been reported even in mild stages of the disease. These functions may play a role in complex daily activities, such as driving. This article provides an overview on the relationships between cognitive functions and driving behavior in PD in driving simulator and on-road studies. The role of attention, executive functions, visual memory, visuospatial construction and information processing speed is discussed. In driving simulator studies, driving performances were correlated with several neuropsychological measures, especially those of Trail Making Test (TMT), Brixton and Symbol Digit Modalities Test. In on-road studies, TMT, Useful Field Of View and Block Design tests appear as good predictors of driving performances. Most of these tests are also relevant to driving in Alzheimer’s disease and traumatic brain injury.

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Driving Cessation and Self-Reported Car Crashes in Older Drivers: The Impact of Cognitive Impairment and Dementia in a Population-Based Study

Cited by 73 publications

References 63 publications

Real-life driving outcomes in Parkinson disease

Real-life driving outcomes in Parkinson disease

The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging

Relationships between Cognitive Functions and Driving Behavior in Parkinson’s Disease

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