Cognitive Impairment and Driving Skills in Youth After Concussion.
Cognitive Impairment and Driving Skills in Youth After Concussion.
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脑震荡后青少年的认知障碍和驾驶技能。
DOI：
10.1089/neu.2022.0308
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发表时间：
2023
影响因子：
4.2
通讯作者：
Patrick,KristinaE
中科院分区：
文献类型：
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作者：
Rivara,FrederickP;Ebel,BethE;Binjolkar,Mayuree;Wang,Jin;Hanron,Amelia;Kroshus,Emily;Boyle,LindaNg;Patrick,KristinaE
脑震荡会影响驾驶所必需的认知过程。年轻人是一个更有可能从事危险行为的群体，他们的驾驶经验有限，机动车碰撞率更高；他们在脑震荡后驾驶障碍的风险可能更高。对于脑震荡后如何恢复驾驶，目前还没有明确的指导方针。我们试图检查年轻司机在脑震荡后接受医疗护理后的模拟驾驶表现，并与类似的对照人群进行比较，以检查驾驶表现与神经心理测试成绩的关系。我们评估了47名16至25岁的司机，在3周内遭受脑震荡，50名具有相似特征的司机没有遭受脑震荡。参与者完成了人口统计问卷、运动脑震荡评估工具-5 （SCAT-5）、一组简短的神经认知测试，包括美国国立卫生研究院工具箱认知电池和造径测试，以及模拟驾驶评估。在模拟驾驶的不同时间，参与者被要求使用触觉检测反应任务（TDRT）对触觉刺激做出反应，这是一种经过验证的模拟驾驶认知负荷测试方法。脑震荡组在SCAT-5测试中报告的症状明显高于对照组。两组在结晶性神经认知技能上的表现相似。脑震荡患者在流体神经认知技能方面的表现明显低于对照组，尽管两组的得分都在正常范围内。模拟驾驶各组之间相似，虽然在速度变化和TDRT失分率方面存在微小但显著的差异，但脑震荡组的表现更差。SCAT-5的症状报告与TDRT漏报率显著相关。此外，神经认知测试分数显著预测TDRT反应时间和失误数，具有中等到较大的效应量。结果表明，神经认知筛查可能是预测恢复驾驶能力的有用工具。然而，需要进一步的研究来确定如何使用神经心理学测试来提出重返驾驶建议和评估脑震荡对现实驾驶的影响的指导方针。
Concussions can impact cognitive processes necessary for driving. Young adults, a group who are more likely to engage in risky behaviors, have limited driving experience and a higher rate of motor vehicle collisions; they may be at higher risk for driving impairment after concussion. There are no clear guidelines for return-to-driving following a concussion. We sought to examine the simulated driving performance of young drivers after receiving medical care following a concussion, compared with a similar control population, to examine the association of driving performance with performance on neuropsychological tests. We evaluated 47 drivers, 16- to 25-year-old, within 3 weeks of sustaining a concussion and 50 drivers with similar characteristics who had not sustained concussions. Participants completed demographic questionnaires, the Sport Concussion Assessment Tool-5 (SCAT-5), and a brief set of neurocognitive tests, including the National Institutes of Health (NIH) Toolbox Cognition Battery and the Trail Making Test, and a simulated driving assessment. At various times during simulated driving, participants were asked to respond to tactile stimuli using the tactile detection response task (TDRT), a validated method of testing cognitive load during simulated driving. The concussion group reported significantly higher symptoms on the SCAT-5 than the comparison group. Performance on crystallized neurocognitive skills was similar between groups. Performance on fluid neurocognitive skills was significantly lower in the concussion than comparison group, although scores were in the normal range for both groups. Simulated driving was similar between groups, although there was a small but significant difference in variation in speed as well as TDRT miss rate, with worse performance by the concussion group. Symptom report on the SCAT-5 was significantly associated with TDRT miss rate. In addition, neurocognitive test scores significantly predicted TDRT reaction time and miss count with medium to large effect sizes. Results suggest that neurocognitive screening may be a useful tool for predicting capacity to return to drive. However, further research is needed to determine guidelines for how neuropsychological tests can be used to make return to driving recommendations and to evaluate effects of concussion on real world driving.