Objective: To determine whether the standard Spanish driving test (ASDE test) was able to identify patients with Parkinson's disease (PD) at risk of unsafe driving and to examine the relationship between the ASDE test and the Useful Field of View (UFOV) as well as with a battery of neuropsychological tests in drivers with PD.
Methods: Thirty-seven patients with PD and 33 controls matched by age and education level were included in an observational study. All participants were active drivers and patients with PD underwent study procedures after taking the medication in the “on” period. Subjects with a Mini-Mental State Examination (MMSE) score ≤ 24 were excluded. Neuropsychological tests (Repeatable Battery for Neuropsychological Status [RBANS], Trail Making Test [TMT-A and -B], and Block Design test), driving performance tests (ASDE Driver Test and UFOV), and daytime sleepiness (Epworth Sleepiness Scale) were assessed.
Results: The PD group performed significantly worse than healthy controls in the ASDE Motor Coordination tests. No significant differences were observed in anticipation speed, multiple reaction time, concentrated attention, and resistance to monotony. All participants successfully completed the UFOV tests. Statistically significant differences between patients with PD and controls were found in processing speed (UFOV1; P =.03) and more patients with PD were found in the categories of higher driving risk levels (P =.03). In addition, patients with PD showed worse scores than healthy controls in visuospatial capacities (Line Orientation), psychomotor speed (Coding and TMT-A), memory (List Recognition, Story Recall), and executive function (TMT-B). The driving tests (ASDE and UFOV) showed a low sensitivity and a high specificity but a higher percentage of patients in the PD group failed in multiple reaction time, concentrated attention, and resistance to monotony. In addition, 18.9% of patients with PD showed a cutoff of 4 for UFOV risk. In the discriminant analysis, Line Orientation (visuospatial/constructive domain) and Figure Recall (delayed memory) were found to be statistically significant with a rate of correct classification of unsafe drivers with PD of 78.2%. In addition, normal results on the Line Orientation item were associated with a 1.5 times higher probability of non-risky driving in the multivariate analysis.
Conclusions: At early stages of the disease, about 19% of patients with PD showed difficulties that may affect their driving capabilities. Line Orientation and Figure Recall are useful to alert clinicians to the risk of unsafe driving. For this reason, patients with PD should be evaluated for driving abilities more regularly to determine the extent of deficits that may influence driving performance. 相似文献
AbstractObjective: Recent news reports in 2016 indicated that across Miami–Dade County, Florida, driving under the influence (DUI) arrests have decreased substantially. The objective of this research was to determine the reasons for the decline in DUI arrests from 2009 to 2016. Are there fewer impaired drivers on the roads? Can DUI enforcement and prosecution be improved?Methods: The following methods were used in this study: (1) Analysis of existing DUI arrest and crash data; (2) conducting and analysis of a telephone survey of reported knowledge, attitudes, and behaviors concerning impaired driving; (3) conducting and analysis of roadside surveys on the roads on weekend nights in Miami–Dade County; (4) information from focus group discussions with police and prosecutors in Miami–Dade County; and (5) a comprehensive review of the best DUI prevention practices and enforcement strategies used across the country.Results: DUI arrests decreased 64% in Miami–Dade County between 2009 and 2016. This was a significantly larger decrease than has occurred in the State of Florida as a whole (34%) and in the United States (29%) over the same time period. The decline was not due to any decline in DUI behavior in the county.Conclusions: Based upon the data and information gathered in this project, the following actions were recommended for Miami–Dade County: (1) County police chiefs need to find ways to overcome law enforcement apathy toward DUI enforcement and persuade their traffic enforcement officers to be proactive rather than reactive when it comes to identifying and making impaired driving stops. (2) County police agencies should join forces to conduct more sobriety checkpoints. Checkpoints are safer for both the police and the drivers going through them and serve as a general deterrent to impaired driving. (3) An interagency DUI task force or team of 5 to 7 officers should be established within the county. These officers would be solely dedicated to DUI enforcement and paid for by each individual agency or under a grant from the state or federal government. 相似文献