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.     

Early impacts of alcoholic beverage warning labels: national study findings relevant to drinking and driving behavior

After November, 1989 Federal law required a standard health warning label on all alcoholic beverage containers sold for consumption in the U.S. Results are reported from a cross-sectional national household telephone interview survey of adults, occurring approximately 6 months after implementation of the warning labels (N=2000). Implications for health warnings with respect to information processing theory, the Health Belief Model, and other theories relevant to precaution adoption are briefly reviewed and two derivative hypotheses are tested using log-linear analysis. Relationships between various personal characteristics and (a) seeing the label and (b) recalling the driving impairment message are examined for consistency with theoretical expectations. We also examine associations between message recall, drinking style, and two precautionary behaviors undertaken to avoid drinking and driving. Adjusting for apparent false positives, approximately a quarter of the sample have noticed the label 6 months after its introduction; 16% recalled the specific driving impairment message. As hypothesized, exposure to the warning was predicted primarily by consumption pattern but also was associated with a personal salience factor, that is, ever having drunk alcohol so as to be at risk when driving. About a quarter of the heavy drinkers (5 drinks or more per occasion sometime and drinking at least weekly) who ever drank and drove saw the specific warning. Of two self-regulation strategies — limiting driving after drinking and limiting drinking when about to drive — the latter was the more prevalent. Both strategies were reported more by those who were heavy drinkers, those recalling the driving impairment message, and those perceiving driving after drinking to be very dangerous, than by other individuals.     

北京市机动车驾驶员“抢行”行为及影响因素分析

机动车驾驶员的"抢行"行为是我国交通事故的主要原因之一。为探索北京市机动车驾驶员的"抢行"行为特征及其影响因素,编制"抢行"行为量表,修订态度和驾驶技术量表,通过在线网站调查收集了486个有效回答。进而分析了个人信息变量对"抢行"行为、态度以及驾驶技术的影响。方差分析的结果表明,男性、年轻、未婚驾驶员报告了更多的"抢行"行为。相关性分析的结果表明反对违规(文中"违规"特指违反交通法规定的行为)的驾驶员"抢行"行为更少,赞成违规的驾驶员更容易采取"抢行"行为,赞成"车让人"的驾驶员往往采取避让行人的行为。     

不同警告方式下驾驶人应激反应能力模拟试验研究

为研究在道路突发危险场景下先进驾驶辅助系统的不同警告方式对驾驶人应激反应能力的影响，利用自主开发的驾驶人应激反应能力测试软件，以计算机模拟与驾驶模拟器为试验平台，以实际驾驶视频为试验场景，选取操作准确率和反应时间为测试指标，分析不同警告方式下驾驶人的应激反应能力。研究结果表明:视觉警告可有效缩短应激反应时间；视听觉组合警告中，视觉警告占主导作用，听觉警告起辅助作用；在真实场景视频试验环境下，驾驶模拟器模拟试验的操作效果优于计算机模拟试验。     

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.     

Implicit attitudes towards risky driving behaviors: Evidence of validity for the implicit association test

Introduction: Attitudes toward risky driving behaviors are commonly evaluated through direct self-report measures. Nevertheless, these instruments have limitations, such as socially-desirable responding. This study examines the validity of the Implicit Association Test (IAT) as an indirect measure of attitudes towards risky driving. An IAT with “risky” vs. “safe” driving behaviors categories was evaluated. Method: A sample of 100 participants (ranging from 18 to 70 years of age) completed the IAT and measures of attitudes, driving styles, personality traits, risk-taking (IOWA Gambling Task), and social desirability (Driver Social Desirability Scale). Results: A high level of internal consistency was found for IAT scores. The IAT was correlated with driving styles (risky, dissociative, and careful dimensions), risk-related personality traits (impulsive/sensation seeking and aggression/hostility) and risk-taking measures. IAT scores were also associated with self-reported risky driving behaviors (r = 0.33). As expected, a higher level of negative implicit attitudes was found among young drivers. The driver social desirability scale was correlated with most self-report measures, but not with the IAT. Conclusion: The present study provides reliability and validity evidence for the IAT as an indirect measure of attitudes towards risky driving. The IAT can serve as an important complement to conventional self-report measures of driving attitudes. Practical Applications: Potential use of global measure of implicit attitudes toward risky driving behaviors in the evaluation, education, and training of drivers are discussed.     

A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD. METHOD: We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties. RESULTS: The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance. CONCLUSIONS: Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance. IMPACT ON INDUSTRY: Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.     

Personality,attitudes and risk perception as predictors of risky driving behaviour among young drivers

Within psychology, different research traditions have attempted to explain individual differences in risky driving behaviour and traffic accident involvement. The present study attempts to integrate two of these research traditions, the personality trait approach and the social cognition approach, in order to understand the mechanisms underlying young drivers' risk-taking behaviour in traffic. The study was based on a self-completion questionnaire survey carried out among 1932 adolescents in Norway. The questionnaire included measures of risk perception, attitudes towards traffic safety and self-reported risk-taking in traffic. Personality measures included aggression, altruism, anxiety and normlessness. The results of a structural equation model suggested that the relation between the personality traits and risky driving behaviour was mediated through attitudes. On this basis it was concluded that personality primarily influences risky driving behaviour indirectly through affecting the attitudinal determinants of the behaviour. Practical implications for traffic safety campaigns are also discussed.     

Associations between driver training, determinants of risky driving behaviour and crash involvement

The core aim of the study is to examine associations between formal and informal practical driver training as well as driving experience on the one hand and young drivers’ safety attitudes, self-assessment of driving ability and self-reported driver behaviour on the other hand. An additional aim is to examine the associations between attitudes, self-assessment and behaviour on the one hand and crash involvement on the other hand. The results are based on a self-completion questionnaire survey conducted among a representative sample of Norwegian drivers aged 18–20 years (n = 1419). The results showed that there were small yet significant associations between driver training, on the one hand and traffic safety attitudes and risky driving behaviour on the other hand. The amount of formal driver training was negatively associated with the respondents’ evaluation of their driving skills; although the amount of lay instruction was positively associated with such self-evaluation. The results also showed that attitudes as well as self-assessment of driving ability were significantly associated with self-reported risk behaviour. This was especially true for attitudes related to rule violations. There was a strong association between crash involvement and exposure (measured as months holding a licence). Young novice drivers’ crash involvement seems stronger associated with driving skills (manifested as self-assessment of driving ability) than safety attitudes and self-reported driver behaviour. The consequences of the results for driver training and accident prevention are discussed.     

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.     

Perceptions and experiences of random breath testing in Queensland and the self-reported deterrent impact on drunk driving

OBJECTIVE: The present study explored the impact of random breath testing (RBT) on the attitudes, perceptions, and self-reported behavior of motorists in the Australian state of Queensland. Particular attention was given to how exposure to RBT impacted motorists' perceived risk of apprehension and self-reported behavior, relative to other variables of interest such as alcohol consumption. METHODS: The study involved a telephone survey of 780 motorists drawn from throughout the state of Queensland. Participants were volunteers recruited from a random sample of all listed telephone numbers in the state, adjusted according to district population figures. The survey questionnaire collected information relating to the participants' socio-demographic characteristics, drinking and drunk driving behaviors, attitudes toward drunk driving and RBT, and experiences and perceptions of RBT. RESULTS: The analysis indicated that a large proportion of the sample had both observed RBT and been breath tested within the last six months and believed the practice served an important role in improving road safety. However, a considerable percentage also reported drunk driving at least once in the last six months without being detected, with further analysis indicating that the threat of apprehension associated with RBT did not appear to greatly influence their offending behavior. Rather, a higher frequency of alcohol consumption, combined with more favorable attitudes to drunk driving and lower levels of support for RBT, appeared to be associated with offending behavior. CONCLUSIONS: While the results confirm the high levels of exposure to RBT achieved in Queensland, the direct impact of recent exposure on drunk driving behavior appears less important than other factors such as alcohol consumption and attitudes to drunk driving and RBT. Further research is required to better understand how recent and lifetime exposure to RBT impacts on motorists' perceived risk of apprehension and subsequent drunk driving behavior.     

Introducing a multi-variate classification method: Risky driving acceptance among different heterogeneous driver sub-cultures

Introduction: Heterogeneous driving populations with many different origins are likely to have various sub-cultures that comprise of drivers with shared driver characteristics, most likely with dissimilar traffic safety cultures. An innovative methodology in traffic safety research is introduced which is beneficial for large datasets with multiple variables, making it useful for the multi-variate classification of drivers, driving attitudes and/or (risky) driving behaviours. Method: With the application of multidimensional scaling analysis (MDS), this study explores traffic safety culture in the State of Qatar using a questionnaire and investigates the similarity patterns between the questionnaire items, aiming to classify attitudes towards risky driving behaviours into themes. MDS is subsequently applied to classify drivers within a heterogeneous driving sample into sub-cultures with shared driver characteristics and different risky driving attitudes. Results: Results show that acceptance of speeding is highest among the young Arabic students and acceptance of distraction and drivers’ negligence such as phone use and not wearing a seatbelt is highest among male Arab drivers. Acceptance of extreme risk-taking like intoxicated driving and red-light running is highest among South-Asian business drivers. Conclusion: It is important and practical to understand risky behavioural habits among sub-cultures and thereby focussing on groups of drivers instead of individuals, because groups are easier to approach and drivers within sub-cultures are found to influence each other. By indicating which groups of drivers are most likely to perform specific risky driving themes, it is possible to target these groups and effectively emphasise certain subsets of risky driving behaviours during training or traffic safety education. Practical Applications: This study provides guidance for the improvement of driver education and targeted traffic safety awareness campaigns, intending to make changes to attitudes and habits within specific driver sub-cultures with the aim to improve traffic safety on the longer term.     

Drug and drink driving by university students: an exploration of the influence of attitudes

The present study aimed to gather information on drug and alcohol use, the prevalence of drink and drug driving and attitudes to both in an undergraduate university cohort (n = 275). Further, the study aimed to contribute information to aid intervention program development by determining predictors of drink and drug driving behavior. The study examines both drug and alcohol use and the influence of attitudes toward driving while under the influence of alcohol and/or drugs. Results indicated that significant proportions of university students are engaging in the risk-taking behavior of driving under the influence of drugs (25%), alcohol (14%), or both (8%). The results suggest that attitudes toward driving under the influence of alcohol and/or drugs are a strong predictor of engaging in the behavior. Peer influence emerged as a major aspect of attitudes. The results of this study provide an important beginning to understanding drink and drug driving and the influence of attitudes in the university student body.     

Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder

INTRODUCTION: Numerous studies have documented an increased frequency of vehicular crashes, traffic citations, driving performance deficits, and driving-related cognitive impairments in teens and adults with attention deficit hyperactivity disorder. METHOD: The present study evaluated the effects of two single, acute doses of methylphenidate (10 and 20 mg) and a placebo on the driving performance of 53 adults with ADHD (mean age=37 years, range=18-65) using a virtual reality driving simulator, examiner and self-ratings of simulator performance, and a continuous performance test (CPT) to evaluate attention and inhibition. A double-blind, drug-placebo, within-subjects crossover design was used in which all participants were tested at baseline and then experienced all three drug conditions. RESULTS: A significant beneficial effect for the high dose of medication was observed on impulsiveness on CPT, variability of steering in the standard driving course, and driving speed during the obstacle course. A beneficial effect of the low dose of medication also was evident on turn signal use during the standard driving course. An apparent practice effect was noted on some of the simulator measures between the baseline and subsequent testing sessions that may have interacted with and thereby obscured drug effects on those measures. CONCLUSIONS: The results, when placed in the context of prior studies of stimulants on driving performance, continue to recommend their clinical use as one means of reducing the driving risks in ADHD teens and adults. IMPACT ON INDUSTRY: Given the significantly higher risk of adverse driving outcomes associated with ADHD, industry needs to better screen for ADHD among employees who drive as part of employment so as to improve safety and reduce costs. Use of stimulants to treat the adult ADHD driver may reduce safety risks.     

Driving and alternatives: older drivers in Michigan

Method: A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive. Results: Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years. Impact on industry: Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.     

Aggressive behavior while driving as predictor of self-reported car crashes

PROBLEM: In Greece, there is a lack of scientific evidence on the relationship between aggressive behavior while driving and young drivers' involvement in car crashes; this study examined this potential relationship. METHODS: The randomly selected samples of 356 young drivers (18-24 years old) were interviewed through a questionnaire of self-reported car crash involvement, which mainly focused on their behavior on the road and the number of car crashes in which they had been involved. RESULTS: The statistical methods used were principal components analysis (PCA) and multiple regression analysis. Two factors relevant to aggressive driving emerged: (a) driving violations and (b) irritability while driving. The multivariate model suggested that driving just for fun (joyriding) and irritability were predictors of young drivers' involvement in car crashes. It was found that younger age was negatively associated with young drivers' involvement in car crashes. IMPACT ON GOVERNMENT AND INDUSTRY: The findings of this study can contribute in the formation of public policies aiming to prevent young drivers' car crashes. These findings can also be the starting point of some health promotion interventions trying to reduce car crashes and casualties on the road. Finally, the insurance companies may be interested in applying these findings into their field of interest.     

The use and safety of medications known to affect driving in Jordan: A cross-sectional study

Objectives: The aim of this study was to estimate the main driving-impairing medications used by drivers in Jordan, the reported frequency of medication side effects, the frequency of motor vehicle crashes (MVCs) while using driving-impairing medicines, as well as factors associated with MVCs.

Methods: A cross-sectional study involving 1,049 individuals (age 18–75 years) who are actively driving vehicles and taking at least one medication known to affect driving (anxiolytics, antidepressants, hypnotics, antiepileptics, opioids, sedating antihistamines, hypoglycemic agents, antihypertensives, central nervous system [CNS] stimulants, and herbals with CNS-related effects) was conducted in Amman, Jordan, over a period of 8 months (September 2013–May 2014) using a structured validated questionnaire.

Results: Sixty-three percent of participants noticed a link between a medicine taken and feeling sleepy and 57% stated that they experience at least one adverse effect other than sleepiness from their medication. About 22% of the participants reported having a MVC while on medication. Multiple logistic regression analysis showed that among the participants who reported having a crash while taking a driving-impairing medication, the odds ratios were significantly higher for the use of inhalant substance (odds ratio [OR] = 2.787, P = .014), having chronic conditions (OR = 1.869, P = .001), and use of antiepileptic medications (OR = 2.348, P = .008) and significantly lower for the use of antihypertensives (OR = 0.533, P = .008).

Conclusion: The study results show high prevalence of adverse effects of medications with potential for driving impairment, including involvement in MVCs. Our findings highlight the types of patient-related and medication-related factors associated with MVCs in Jordan, such as inhalant use, presence of chronic conditions, and use of antiepileptics.