Longitudinal driving performance in early-stage dementia of the Alzheimer type
Longitudinal driving performance in early-stage dementia of the Alzheimer type
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DOI：
10.1046/j.1532-5415.2003.51481.x
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发表时间：
2003-10-01
影响因子：
6.3
通讯作者：
Morris, JC
中科院分区：
文献类型：
--
作者：
Duchek, JM;Carr, DB;Morris, JC
目的：纵向评估健康老年人和早期阿尔茨海默型痴呆（DAT）患者的道路驾驶表现。设计：前瞻性纵向研究。地点：大型城市医疗中心及周边地区。参与者：58名健康对照者，21名轻度DAT参与者，29名轻度DAT参与者。DAT的诊断使用有效的临床诊断标准，并根据临床痴呆评定（CDR）Scale.MEASUREMENTS分期：健康对照组和非常轻度DAT和轻度DAT的个体在重复的测试时间内进行标准化的道路驾驶评估。CDR = 1组中的受试者（轻度DAT）在驾驶测试中接受不安全评级的速度比CDR = 0组的受试者更快（健康对照;对数秩检验，P = .006），CDR = 0.5组（非常轻微的DAT）的生存函数落在CDR = 0和CDR = 1组之间。考克斯比例风险模型表明，基线年龄控制后，CDR = 0和CDR = 1组之间的生存函数存在显著差异（P < .001）。考克斯回归分析还表明，基线年龄是一个显着的危险因素的评级“不安全”（P = .002）。结论：这项研究提供了纵向证据的驾驶性能下降，随着时间的推移，主要是在早期DAT，并支持不仅需要驾驶评估，但也为重新评估个人非常温和和温和的DAT。
OBJECTIVES: To longitudinally assess on-road driving performance in healthy older adults and those with early-stage dementia of the Alzheimer type (DAT).DESIGN: A prospective longitudinal study.SETTING: Large urban medical center and surrounding area.PARTICIPANTS: A sample of 58 healthy controls, 21 participants with very mild DAT, and 29 participants with mild DAT participated. DAT was diagnosed using validated clinical diagnostic criteria and staged according to the Clinical Dementia Rating (CDR) Scale.MEASUREMENTS: Healthy controls and individuals with very mild DAT and mild DAT were administered a standardized on-road driving assessment over repeated times of testing.RESULTS: Subjects in the CDR = 1 group (mild DAT) had a faster rate of receiving a rating of not safe on the driving test than subjects in the CDR = 0 group (healthy controls; log rank test, P = .006), and the survival function of the CDR = 0.5 group ( very mild DAT) fell between those of the CDR = 0 and CDR = 1 groups. A Cox proportional hazards model indicated a significant difference in survival functions between the CDR = 0 and CDR = 1 groups after baseline age was controlled for (P < .001). Cox regression analysis also indicated that baseline age was a significant risk factor for a rating of "not safe'' (P = .002).CONCLUSION: This study provides longitudinal evidence for a decline in driving performance over time, primarily in early-stage DAT, and supports the need not only for driving assessments, but also for reevaluation of individuals with very mild and mild DAT.