Driving ability and cognitive dysfunction in senile dementia and depression

目的：近年来，由老年驾驶员造成的机动车事故呈上升趋势。本研究旨在利用驾驶模拟器评估早期痴呆或老年性抑郁症患者的驾驶行为。并对驾驶能力与神经心理测试成绩的关系进行了探讨。方法：研究对象包括11例早期痴呆患者(CDR0.51.0)、16例轻中度抑郁症患者和11例局灶性脑损害患者。在受试者中，有三人直接经历了轻微的汽车损坏。基本神经心理学检查包括智力状态测验、Ravexf彩色累进矩阵、韦氏成人智力量表修订版、韦氏记忆量表修订版、威斯康星卡片分类测验、连线测验和改良Stroop测验。驾驶模拟器(AC110，TaskNet Inc.)被引入进行评估，以及(1)。仅按下刹车踏板，(2)。刹车和油门踏板，(3)。仅处理操作，(4)。(2)(3)的组合进行检验。结果：通过与AC110年龄匹配的正常数据库比较来评估患者的表现。轻度痴呆患者在驾驶模拟器评估的各个方面都受损[(1)4]抑郁症患者在联合操作任务中特别受损(4)。从实际驾驶的角度来看，精确度似乎比速度更重要。不能准确操纵手柄和踏板组合动作的受试者应被建议不要开车或小心驾驶。一般智力和记忆力与驾驶活动无关。相反，额叶功能，特别是改良的Stroop测验，与驾驶表现有一定的相关性。结论：驾驶发音测验的评估部分反映了早期痴呆和老年抑郁症的认知问题。

Objective : Motor vehicle accidents caused by old-age drivers have been increasing in recent years. The present research aimed to evaluate driving performance of patients with early dementia or senile depression with a driving simulator. The relation between driving ability and performance onieuropsychologicaltests were also investigated. Methods : Subjects included 11 dementia patients at early stage (CDR 0.51.0), 16 senile depression patients in mild to moderate severity and 11 patients with focal brain damage. Three among the subjects reactly experienced mild car damage. Basic neuropsychological examination included MinMental State Examination, Ravexfs Colored Progressive Matrices, Wechsler Adult Intelligence Scale- Revised, Wechsler Memory Scale - Revised, Wisconsin Card Sorting Test, Trail Making Test, and modified Stroop Test. The driving simulator (AC110, TaskNet Inc) was introduced for evaluation, and (1). brake pedal pressing only, (2). both brake and accelerator pedals, (3). handle manipulation only, (4). combination of (2)(3) wereexamined.Results : Performance of the patients was assessed in comparison of agenatched normal data base for AC110. Patients with mild dementia were impaired in all aspects of driving simulator evaluation [(1()4)] Patients with depression were specifically impaired in combined manipulation tasks (4). From the viewpoint of actual driving, accuracy appeared to be more important than speed. Subjects who were inaccurate in manipulating combined handle and pedal movements should be advised not to ciriveor drive with caution. General intelligence and memory did not relate with driving activities. In contrast, frontal functions, specifically modified Stroop test, showed some correlations with driving performance.Conclusions : Evaluation with driving sinulator partially reflects cognitive problems in early dementia and senile depression.