Driving with a neurodegenerative disorder: an overview of the current literature

Jacobs, Milou; Hart, Ellen P.; Roos, Raymund A.C.

doi:10.1007/s00415-017-8489-9

Cited by 33 publications

(25 citation statements)

References 110 publications

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“…One should be very careful in arguing that it can be temporarily advised to drive for patients with AD based on an MMSE score ≥ 25, which was proposed by Versijpt and colleagues [ 7 ]. The MMSE is a short screening for global cognitive functioning, which may insufficiently cover several cognitive domains that are highly relevant for driving, namely visuospatial abilities and executive functions [ 14 , 15 , 23 , 24 ]. Patients with cognitive impairments in these domains may be unsafe drivers, even when having high MMSE scores due to relatively preserved orientation and language functions.…”

Section: Discussionmentioning

confidence: 99%

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer’s dementia

et al. 2018

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Since Alzheimer’s disease may affect driving performance, patients with Alzheimer’s disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer’s disease will pass or fail an on-road driving assessment. Patients with Alzheimer’s disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811–819, 2017]. All patients with Alzheimer’s disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer’s disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer’s disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.

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Section: Discussionmentioning

confidence: 99%

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer’s dementia

et al. 2018

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“…Hence, we suggest that assessing emotion recognition may be a valuable supplement in the assessment of fitness to drive in patients with an NDD. This can be helpful, because finding contributing factors to the fitness to drive in these patients is still a topic of ongoing debate (Jacobs, Hart, & Roos, 2017). Future studies are needed to extend these results by looking at the role of facial emotion recognition in risk-taking behavior in on-road driving behavior and to investigate this relationship in the separate NDD patient groups.…”

Section: Discussionmentioning

confidence: 99%

Emotion Recognition and Traffic-Related Risk-Taking Behavior in Patients with Neurodegenerative Diseases

Berg

Reesink

Haan

et al. 2020

J Int Neuropsychol Soc

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Objectives: Neurodegenerative diseases (NDDs), such as Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, and Huntington’s disease, inevitably lead to impairments in higher-order cognitive functions, including the perception of emotional cues and decision-making behavior. Such impairments are likely to cause risky daily life behavior, for instance, in traffic. Impaired recognition of emotional expressions, such as fear, is considered a marker of impaired experience of emotions. Lower fear experience can, in turn, be related to risk-taking behavior. The aim of our study was to investigate whether impaired emotion recognition in patients with NDD is indeed related to unsafe decision-making in risky everyday life situations, which has not been investigated yet. Methods: Fifty-one patients with an NDD were included. Emotion recognition was measured with the Facial Expressions of Emotions: Stimuli and Test (FEEST). Risk-taking behavior was measured with driving simulator scenarios and the Action Selection Test (AST). Data from matched healthy controls were used: FEEST (n = 182), AST (n = 36), and driving simulator (n = 18). Results: Compared to healthy controls, patients showed significantly worse emotion recognition, particularly of anger, disgust, fear, and sadness. Furthermore, patients took significantly more risks in the driving simulator rides and the AST. Only poor recognition of fear was related to a higher amount of risky decisions in situations involving a direct danger. Conclusions: To determine whether patients with an NDD are still fit to drive, it is crucial to assess their ability to make safe decisions. Measuring emotion recognition may be a valuable contribution to this judgment.

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“…Studies assessing driving competence in HD patients also showed that visual processing speed, visual scanning, and visual attention are more sensitive predictors of performance on on-road driving assessments, compared to motor functioning. 83,84 The assessment of visual cognitive impairment is therefore of clinical importance as it can have implications in daily functioning, such as the impact on driving performance, the use of electronic devices and subsequently affects participating in social activities. For example, the impairment to recognize negative facial emotions, such as anger, disgust and fear, could affect communication and social relationships.…”

Section: Discussionmentioning

confidence: 99%

The visual cortex and visual cognition in Huntington’s disease: An overview of current literature

Coppen

Hart

Lakke

et al. 2018

Behavioural Brain Research

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The processing of visual stimuli from retina to higher cortical areas has been extensively studied in the human brain. In Huntington's disease (HD), an inherited neurodegenerative disorder, it is suggested that visual processing deficits are present in addition to more characteristic signs such as motor disturbances, cognitive dysfunction, and behavioral changes. Visual deficits are clinically important because they influence overall cognitive performance and have implications for daily functioning. The aim of this review is to summarize current literature on clinical visual deficits, visual cognitive impairment, and underlying visual cortical changes in HD patients. A literature search was conducted using the electronic database of PubMed/Medline. This review shows that changes of the visual system in patients with HD were not the primary focus of currently published studies. Still, early atrophy and alterations of the posterior cerebral cortex was frequently observed, primarily in the associative visual cortical areas such as the lingual and fusiform gyri, and lateral occipital cortex. Changes were even present in the premanifest phase, before clinical onset of motor symptoms, suggesting a primary region for cortical degeneration in HD. Although impairments in visuospatial processing and visual perception were reported in early disease stages, heterogeneous cognitive batteries were used, making a direct comparison between studies difficult. The use of a standardized battery of visual cognitive tasks might therefore provide more detailed information regarding the extent of impairments in specific visual domains. Further research could provide more insight into clinical, functional, and pathophysiological changes of the visual pathway in HD.

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Driving with a neurodegenerative disorder: an overview of the current literature

Cited by 33 publications

References 110 publications

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer’s dementia

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer’s dementia

Emotion Recognition and Traffic-Related Risk-Taking Behavior in Patients with Neurodegenerative Diseases

The visual cortex and visual cognition in Huntington’s disease: An overview of current literature

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