Assessment of Driving-Related Skills Prediction of Unsafe Driving in Older Adults in the Office Setting
Assessment of Driving-Related Skills Prediction of Unsafe Driving in Older Adults in the Office Setting
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DOI：
10.1111/jgs.12306
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发表时间：
2013-07-01
影响因子：
6.3
通讯作者：
Carr, David B.
中科院分区：
文献类型：
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作者：
Ott, Brian R.;Davis, Jennifer D.;Carr, David B.
目的：为了检验驾驶相关技能评估（ADReS）的敏感性和特异性，ADReS是美国医学会推荐的一种临床工具，用于识别潜在的不安全老年驾驶员，包括视力、运动功能和认知测试。驾驶员认知正常（n = 47）和认知障碍（n = 75）。测量：神经科医生完成了ADReS在办公室访问。还进行了执行、视觉空间和视觉功能的其他认知测试。在单独的一天，参与者完成了标准化的道路测试，由专业驾驶教练使用全球安全评级和定量驾驶score.Results：在这个样本中，目前活跃的老年驾驶员有和没有认知障碍，认知措施，特别是小道制作测试部分B，驾驶分数比其他措施的功能更高度相关。使用推荐的评分程序，ADReS在道路测试中检测受损驾驶的灵敏度为0.81，特异性为0.32，受试者工作特征曲线下面积（AUC）为0.57。Logistic回归模型，结合计算机迷宫任务和简易精神状态检查分数提高了整体分类的准确性，得到的灵敏度为0.61，特异性为0.84，和AUC为0.80。结论：在其目前的形式，ADReS作为办公室筛选个人谁应该接受正式的驾驶评估的效用有限。在一般诊所实践中，需要改进评分方法和筛查试验，使其诊断准确性高于ADReS。
OBJECTIVES: To examine the sensitivity and specificity of the Assessment of Driving-Related Skills (ADReS), a clinical tool recommended by the American Medical Association for identifying potentially unsafe older drivers that includes tests of vision, motor function, and cognition.DESIGN: Cross-sectional observation study.SETTING: Memory assessment outpatient clinic of a university hospital.PARTICIPANTS: Drivers with normal cognition (n = 47) and cognitive impairment (n = 75).MEASUREMENTS: A neurologist completed the ADReS during an office visit. Additional cognitive tests of executive, visuospatial, and visuomotor function were also performed. On a separate day, participants completed a standardized on-road test, assessed by a professional driving instructor using a global safety rating and a quantitative driving score.RESULTS: In this sample of currently active older drivers with and without cognitive impairment, measures of cognition-particularly the Trail-Making Test Part B-were more highly correlated with driving scores than other measures of function. Using recommended scoring procedures, the ADReS had a sensitivity of 0.81 for detecting impaired driving on the road test, with a specificity of 0.32 and an area under the receiver operating characteristic curve (AUC) of 0.57. A logistic regression model that incorporated computerized maze task and Mini-Mental State Examination scores improved overall classification accuracy, yielding a sensitivity of 0.61, a specificity of 0.84, and an AUC of 0.80.CONCLUSION: In its present form, the ADReS has limited utility as an office screen for individuals who should undergo formal driving assessment. Improved scoring methods and screening tests with greater diagnostic accuracy than the ADReS are needed for general office practice.