The Impact of Depression and Preclinical Alzheimer Disease on Driving Among Older Adults

项目摘要/摘要 我们的长期目标是准确识别谁有驾驶下降的风险，并预测何时下降 将会发生，并在下降之前进行干预，从而减少在 上了年纪的人。我们的发现表明，阿尔茨海默病(AD)的长期临床前阶段，如 认知正常人群中淀粉样蛋白成像和脑脊液(CSF)生物标记物相关 在标准化路考中的驾驶表现较差。这个项目将评估抑郁症是如何， 临床前AD和抗抑郁药影响认知正常老年人的驾驶行为(≥65岁)。 这项研究意义重大，因为3600万持有执照的司机年龄在65岁或以上，而 预计到2050年，美国老年人的数量将翻一番，届时每4名司机中就有一人年龄为65岁 或者更老。机动车撞车事故是老年人伤亡的主要原因(每天有814起车祸)。 驾驶是一项对认知要求很高的活动，也是一种高度动态的活动。抑郁症和症状性AD独立存在 增加了车祸的风险。抑郁也是转化为症状性阿尔茨海默病的一个因素，但它是 常被用作衰老研究的排除标准。抑郁症和抗抑郁剂的不良影响 在驾驶中使用，抑郁症对AD的影响是有记录的；但对协同作用的理解 这三个领域之间缺乏联系。 我们的具体目标将(1)描述重度抑郁症(诊断)和 一项前瞻性的纵向研究中的自然主义驾驶行为，(2)检查重度抑郁症和 临床前AD联合预测老年人驾驶行为的纵向变化更快，(3)评估 药物(抗抑郁药)、重度抑郁症和临床前AD对自然驾驶的影响。 为了测试这些具体目标，我们组建了一个拥有AD专业知识的多学科团队， 抑郁症、神经成像生物标记物、脑脊液生物标记物、自然驾驶、认知和大脑老化，以及 纵向生物统计学方法。我们将利用现有基础设施来跟踪目前已注册的70名员工 并招募另外70名患有抑郁症的参与者，以创建一个140人的队列。这 Cohort将利用一种自然主义的驾驶方法来捕捉他们每天的驾驶行为 基础。每年将使用临床痴呆症评定量表和各种心理测量法对他们的认知进行测试 措施。参与者抑郁的特征将使用迷你国际神经精神病学访谈 (迷你)和9项患者健康问卷(PHQ-9)。 一旦获得这些知识，就可以用来创建适合阶段的、个性化的、与驾驶相关的 安全策略，可在诊断后实施，并在疾病进展过程中进行调整。

PROJECT SUMMARY/ABSTRACT Our long-term goal is to accurately identify who is at risk of decline in driving, to forecast when decline will occur, and to intervene before decline, thereby reducing the numbers of crashes, injuries, and death in older adults. Our findings indicate that the long preclinical stage of Alzheimer disease (AD), as reflected in amyloid imaging and cerebrospinal fluid (CSF) biomarkers among cognitively normal persons, is associated with poorer driving performance on a standardized road test. This project will assess how depression, preclinical AD, and antidepressants affect driving behavior in cognitively normal older adults (≥ 65 years). This research is significant because 36 million licensed drivers are aged 65 years or older, and the number of older adults in the United States is expected to double by 2050, when 1 in 4 drivers will be 65 years or older. Motor vehicle crashes are a leading cause of injury and death in older adults (814 daily crashes). Driving is a cognitively demanding and highly dynamic activity. Depression and symptomatic AD independently increase the risk of an automobile crash. Depression is also a factor for conversion to symptomatic AD, yet it is often used as an exclusion criterion for aging studies. The adverse impact of depression and antidepressant use on driving, and the impact of depression on AD is documented; yet an understanding of the synergy between these three areas is lacking. Our Specific Aims will (1) characterize the relationship between major depression (diagnosis) and naturalistic driving behavior in a prospective, longitudinal study, (2) examine whether major depression and preclinical AD, combined, predict faster longitudinal change in driving behavior among older adults, (3) assess the impact of medications (antidepressants), major depression, and preclinical AD on naturalistic driving. To test these Specific Aims, we have assembled a multidisciplinary team with expertise in AD, depression, neuroimaging biomarkers, CSF biomarkers, naturalistic driving, cognitive and brain aging, and longitudinal biostatistical methods. We will capitalize on existing infrastructure to follow 70 currently enrolled individuals and enroll an additional 70 participants with depression, to create a cohort of 140 individuals. This cohort will utilize a naturalistic driving methodology that will capture their driving behaviors on an everyday basis. Their cognition will be tested annually using the Clinical Dementia Rating and various psychometric measures. Participant depression will be characterized using the Mini-International Neuropsychiatric Interview (MINI) and the 9-item Patient Health Questionnaire (PHQ-9). Once obtained, this knowledge can be used to create stage-appropriate, personalized, driving-related safety strategies that can be implemented upon diagnosis, and adjusted throughout disease progression.