Predicting Driver Safety in Parkinson's Disease

描述(申请人提供)：汽车驾驶是日常生活中的一个重要方面，但车祸造成了严重的公共健康问题。帕金森氏症(PD)的司机由于运动功能、认知和日间唤醒的进行性损害而面临着特别的撞车风险。一些患有帕金森氏症的司机特别有可能在受损时驾驶，因为他们没有意识到性能受损，他们的医生也不知道。对患有帕金森病的高危司机是否适合驾驶的判断应该依赖于对表现的经验观察，因为仅基于医疗诊断或年龄的决定可能不公平地剥夺患者的机动性，或者不明智地授权不适合的司机获得执照。我们建议通过在实验中测试一组假设来扩展对帕金森病驾驶安全的现有知识，这些假设将评估(1)使用标准化的帕金森症测量的运动功能，(2)使用标准化的神经心理测试(注意力、知觉、记忆和执行功能)的认知功能，(3)白天唤醒(标准的嗜睡和盖子关闭的监测)，以及(4)在仪表式车辆和最先进的交互式驾驶模拟器中测量的驾驶表现。我们对帕金森病司机的初步研究表明了这种方法的可行性。模拟器使在对驾驶员和测试员来说既具有挑战性又安全的环境中通过最佳刺激和响应控制来观察驾驶员错误成为可能。该项目的参与者将是115名合法持有帕金森病执照的司机和同等数量的没有神经系统疾病的对照司机。考虑到自然减员的因素，115名帕金森病患者中的100名将在初步驾驶评估两年后重新测试，以衡量帕金森病进展对司机安全的影响。我们的目标是增加对帕金森病相关的运动功能障碍、认知障碍和日间觉醒障碍在驾驶安全错误中的作用的理解。更好地了解帕金森病患者的驾驶能力如何恶化，以及司机是否意识到自己的损害，是合理制定干预措施、帮助防止帕金森氏症患者撞车的必要步骤。这项研究中使用的技术最终可能被用来开发未来的工具，用于筛查、识别、建议和提醒患有帕金森病的司机，这些司机有更大的驾驶受损风险。公平和准确地检测患有帕金森病的不健康司机将有助于减轻由这些受损个人造成的机动车碰撞的悲剧。

DESCRIPTION (provided by applicant): Automobile driving is a crucial aspect of everyday life, yet vehicular crashes pose a serious public health problem. Drivers with Parkinson's disease (PD) are at special risk for a crash due to progressive impairments of motor function, cognition, and daytime arousal. Some drivers with PD are especially likely to drive while impaired because they are not aware of performance impairments, and neither are their physicians. Judgments on fitness to drive in at-risk drivers with PD should rely upon empirical observations of performance, because decisions based on medical diagnosis or age alone may unfairly deny patients their mobility or unwisely authorize licensure in unfit drivers. We propose to expand the available knowledge of driving safety in PD by testing a set of hypotheses in experiments that will assess (1) motor function using standardized measures of parkinsonism, (2) cognitive functions using standardized neuropsychological tests (of attention, perception, memory, and executive functions), (3) daytime arousal (standard self-ratings of sleepiness and monitoring of lid closure), and (4) driving performance as measured in an instrumented vehicle and a state-of-the-art interactive driving simulator. Our pilot study of drivers with PD shows the feasibility of this approach. Simulators make it possible to observe driver errors with optimal stimulus and response control in an environment that is challenging yet safe for the driver and tester. Participants in this project will be 115 legally licensed drivers with PD and an equal number of control drivers without neurological disease. Allowing for attrition, 100 of these 115 drivers with PD will be re-tested two years after the initial driving assessment to measure effects of PD progression on driver safety. Our goal is to increase understanding of the role of PD-related motor dysfunction, cognitive impairment, and daytime arousal disorders in driving safety errors. A better understanding of how driving performance deteriorates in PD and whether drivers are even aware of their impairment is a necessary step in the rational development of interventions that could help prevent crashes by patients with PD. The techniques used in this study could ultimately be adapted to develop future tools for screening, identifying, advising, and alerting drivers with PD who are at greater risk for impaired driving. Fair and accurate means of detecting unfit drivers with PD will help mitigate the tragedy of motor vehicle crashes caused by these impaired individuals.