Assessing fitness to drive—A validation study on patients with mild cognitive impairment

Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).

Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.

Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.

Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.     

Car drivers with dementia: Different complications due to different etiologies?

Objective: Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability.

Methods: The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar.

Results and Conclusions: Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia etiologies are taken into consideration.     

On-road driving evaluations: a potential tool for helping older adults drive safely longer

PROBLEM: This paper explores the potential use of on-road driving evaluations as a tool for helping older adults extend their safe driving years. METHOD: Three separate research activities were carried out. The first was a national telephone survey of current and former older drivers. The results of this survey provide information relevant to the potential market for on-road driving evaluations. The second was a series of focus groups with potential stakeholders in the process: driver educators, occupational therapists, and physicians. These groups explored the feasibility and requirements of offering on-road driving evaluations to the wider public. Supplemental data were also collected from a mail survey of driving schools nationwide. RESULTS: Based on the results of these efforts, a number of recommendations are presented for expanding the availability of on-road driving evaluations, specifically to help older adults make more responsible decisions about continuing or stopping driving, and more generally to help them drive safely longer.     

Assessment of patients' medical fitness to drive by primary care physicians: A cross-sectional study

Objectives: Motor vehicle collisions (MVCs) are a significant health burden in Saudi Arabia. The literature has consistently indicated that chronic medical conditions, such as diabetes, heart disease, stroke, obstructive sleep apnea, and neurodevelopmental disorders, increase the risk of MVCs. Therefore, assessment of driver fitness by primary care physicians (PCPs) remains a major health intervention that might reduce MVCs. We studied the practices of PCPs in assessing medical fitness to drive in at-risk patients.

Methods: We conducted a cross-sectional study of all 88 government-funded primary care centers in the city of Riyadh, Saudi Arabia. We administered a self-reported questionnaire to PCPs that inquired about their driving risk assessment for specific medical conditions.

Results: Among all PCPs and centers, 189 PCPs (63%) from 74 centers (84%) participated in our survey. The mean age of the PCPs was 40 ± 10 years, and 108 (57%) were men. The average clinical experience of the group was 13 ± 9 years. Fewer than half of PCPs considered diabetes mellitus (45%) and obstructive sleep apnea (46%) as potential risks for MVCs. Approximately 45% of PCPs did not notify any authority or relatives of potential driving issues that they noticed in their patients. Only 15% of the participants believed that PCPs were responsible for alerting authorities about their fitness to drive.

Conclusions: PCPs did not adequately assess their patients' driving history and eligibility. Efforts are needed to improve awareness among PCPs regarding the effects of chronic medical conditions on driving.     

长时间单调模拟驾驶对疲劳的影响研究

通过模拟驾驶实验,综合评估长时间驾驶以及单调环境对驾驶员疲劳程度的影响是笔者研究的主要课题内容.借助于在模拟驾驶座舱上,4个健康样本分别参加高速公路(单调环境)和一般公路(非单调环境)的两组驾驶仿真实验,每组测试均持续两小时,一共进行10次实验.实验过程中,样本的操控数据(车速和方向盘转角)、反应时间、心电信号、主观疲劳状况等都同步记录并保存.实验结果表明长时间驾驶对操控能力、反应时间、心率、主观疲劳都有显著性影响(p＜0.050),单调环境(高速公路)和非单调环境(一般公路)相比,车速方差区别显著,而尽管被试在高速公路的单调环境下驾驶后主观感觉更疲劳一些,但反应时间、心率等因素并没有显著性差异.     

Near-crash事件中驾驶人行为特征分析

为研究不同驾驶人在追尾事故中的驾驶行为特征,用Near-crash事件代替真实碰撞事件,选取一段城市快速道路开展实车试验。首先测试21名驾驶人实驾时的最大减速度、制动至最大减速度时间、平均减速度、碰撞时间倒数(TTCi)4个指标;然后用Mobileye等设备提取数据,得到不同性别、驾驶经验、驾驶风格的驾驶人指标因素;最后对数据进行方差分析。结果表明:Near-crash事件中,女性驾驶人平均减速度、最大减速度大于男性驾驶人,女性驾驶人更倾向于急刹车;经验影响驾驶人的平均减速度、最大减速度;熟练驾驶人制动到最大减速度时间长,制动过程更加平稳;激进型驾驶风格的驾驶人车头时距(THW)小于保守型驾驶人。     

不同训练维度下新手驾驶人潜在危险认知能力研究

为完善我国驾驶人安全教育体系,预防由驾驶人引发的交通事故,选取潜在危险认知通过率、危险区域正确判断率、避险操作准确度为评价指标,利用自主开发的测试培训软件,采集36名被试的数据,分析不同训练频次及丰富度下,新手驾驶人潜在危险认知能力的提升效果。结果表明:反复训练可使驾驶人潜在危险认知能力提高并保持稳定;相较于低频训练,3～6天/次的高、中频训练效果更明显;相较于简单训练,有针对性教育指导的多样训练使驾驶人能力提升更快;有限的训练条件下,进行6～8次多样训练效果较好。     

A novel driver hazard perception sensitivity model based on drivers’ characteristics: A simulator study

Objective: Considering the high annual number of fatal driving accidents in Iran, any approach for reducing the number or severity of driving accidents is a positive step toward decreasing accident-related losses. Accidents can often be avoided by a timely reaction of the driver. One of the steps before reacting to a hazard is perception. Some driver characteristics may affect road hazard perception. In this research, it was assumed that various driver characteristics, including demographic characteristics and cognitive characteristics, have an impact on driver perception.

Methods: The driving simulator used in this research provides various scenarios; for example, passing a pedestrian or animal across the road or placing fixed objects in a 2-lane separated rural road for 2 groups of experienced and inexperienced drivers under day and night lighting conditions. The go/no-go test was carried out in order to assess drivers’ attention to driving tasks and inhibitory control. A structural equation model (SEM) was used to estimate the relation between driver characteristics and sensitivity to road hazard perception. A new hazard perception index was proposed based on the time intervals in the hazard vulnerability.

Results: The results show that the most effective variables in the analysis of sensitivity to hazard perception are driving experience (in kilometers) during the last 3 years and road lighting conditions. Moreover, hazard perception sensitivity was improved by better inhibitory control, selective attention, and decision making, more carefulness, the average amount of daily sleep, and marital status.

Conclusion: The results of this research may be useful in educating and advertising programs. It also could enhance sensitivity to perception of hazards such as pedestrians, animals, and fixed obstacles among young and novice drivers.     

Safety assessment of automated vehicles: how to determine whether we have collected enough field data?

Abstract

Objective: The amount of collected field data from naturalistic driving studies is quickly increasing. The data are used for, among others, developing automated driving technologies (such as crash avoidance systems), studying driver interaction with such technologies, and gaining insights into the variety of scenarios in real-world traffic. Because data collection is time consuming and requires high investments and resources, questions like “Do we have enough data?,” “How much more information can we gain when obtaining more data?,” and “How far are we from obtaining completeness?” are highly relevant. In fact, deducing safety claims based on collected data—for example, through testing scenarios based on collected data—requires knowledge about the degree of completeness of the data used. We propose a method for quantifying the completeness of the so-called activities in a data set. This enables us to partly answer the aforementioned questions.

Method: In this article, the (traffic) data are interpreted as a sequence of different so-called scenarios that can be grouped into a finite set of scenario classes. The building blocks of scenarios are the activities. For every activity, there exists a parameterization that encodes all information in the data of each recorded activity. For each type of activity, we estimate a probability density function (pdf) of the associated parameters. Our proposed method quantifies the degree of completeness of a data set using the estimated pdfs.

Results: To illustrate the proposed method, 2 different case studies are presented. First, a case study with an artificial data set, of which the underlying pdfs are known, is carried out to illustrate that the proposed method correctly quantifies the completeness of the activities. Next, a case study with real-world data is performed to quantify the degree of completeness of the acquired data for which the true pdfs are unknown.

Conclusion: The presented case studies illustrate that the proposed method is able to quantify the degree of completeness of a small set of field data and can be used to deduce whether sufficient data have been collected for the purpose of the field study. Future work will focus on applying the proposed method to larger data sets. The proposed method will be used to evaluate the level of completeness of the data collection on Singaporean roads, aimed at defining relevant test cases for the autonomous vehicle road approval procedure that is being developed in Singapore.     

安全状态评价模型构模原理及其状态程度与状态存在程度的表达方法研究

运用系统科学理论对安全状态评价模型构模原理进行阐述;根据评价系统状态的模糊性特征,结合人们对安全状态的认识、理解和接受方式,提出了评价系统状态程度与状态存在的可能性多值表达方法     

自适应巡航控制系统对驾驶安全性的影响研究

为探究自适应巡航控制(ACC)系统对驾驶安全性的影响,首先通过实际道路驾驶试验获取我国典型道路交通场景,用驾驶模拟器进行场景仿真,并在有/无ACC状态下开展模拟驾驶试验;然后分析ACC系统在中国典型道路中的表现,通过对比分析ACC模式下不同特征驾驶人的碰撞时间(TTC),探讨不同类型驾驶人的应急反应。结果表明,ACC能较好地处理大多数路况;但面对危险路况时,不管是哪种类型的驾驶人,ACC的应急反应都没有手动驾驶迅速;且女性、年老和对ACC认知度低的驾驶人更容易受ACC的不良影响;驾驶人对ACC的认知度决定其ACC驾驶的安全性。     

面向驾驶员心电数据的交叉口驾驶风险评估方法

为更精准地评估交叉口范围内的驾驶风险,首先,引入驾驶员心电(EGG)数据,提出基于余弦相似性距离的逼近理想解排序(TOPSIS)模型;其次,建立滚动时间窗法,并改进传统的短期频域指标计算方法,计算模型中低频(LF)变化率指标和低频与高频之比(LF/HF)等心率变异性(HRV)指标,模型时域指标有心脏搏动周期(R-R间期)变化率和其标准差(SDNN);然后,根据心电频域和时域指标与静息状态下对应指标的接近程度进行综合排序,按照越接近驾驶风险越小的原则,评估交叉口区域的驾驶风险;最后,选择30名驾驶员,在西安市23个交叉口开展实车试验,采集试验数据并验证模型方法。结果表明:驾驶员在相同交叉口环境下的驾驶风险评估结果相似性超90.1%,所提方法可应用稀疏样本评估交叉口的整体驾驶风险;高驾驶风险的交叉口评估方差较中、低驾驶风险路口分别高38.8%和67.9%,表明低风险交叉口区域驾驶风险的评估更精准。     

Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes

PROBLEM: To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator, and to determine which measures were associated with the occurrence of motor-vehicle crash. METHOD: One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study. Using the driving simulator, appropriate driving tasks were devised to test the older drivers, whose performances were assessed by 10 reliable assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome. RESULTS: As expected, driving skill of older drivers was found to decline with age. Over 60% of the sample participants reported having at least one motor-vehicle crash during the past year. Adjusting for age in a logistic regression analysis, the cognitive abilities associated with the crash occurrence were working memory, decision making under pressure of time, and confidence in driving at high speed. SUMMARY: The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator. Prospective studies need to be undertaken to determine whether the driving simulator can predict future crash events. IMPACT ON INDUSTRY: This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered.