Predicting Driver Safety in Parkinson's Disease

描述（由申请人提供）：汽车驾驶是日常生活的一个重要方面，但汽车碰撞造成了严重的公共卫生问题。患有帕金森病（PD）的司机由于运动功能、认知和白天觉醒的进行性损伤而处于撞车的特殊风险中。一些患有帕金森病的司机尤其有可能在受损时开车，因为他们没有意识到自己的表现受损，他们的医生也没有意识到。对于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其表现的经验观察，因为仅仅基于医学诊断或年龄的决定可能会不公平地剥夺患者的行动能力，或者不明智地批准不适合驾驶的司机驾驶。我们建议通过在实验中测试一组假设来扩展PD驾驶安全的可用知识，这些假设将评估(1)使用帕金森病的标准化测量的运动功能，(2)使用标准化神经心理学测试的认知功能（注意，感知，记忆和执行功能），(3)白天唤醒（标准睡意自评和盖子闭合监测），(4)在仪表化车辆和最先进的交互式驾驶模拟器中测量的驾驶性能。我们对PD驱动程序的初步研究表明了这种方法的可行性。模拟器可以在具有挑战性但对驾驶员和测试人员安全的环境中，通过最佳刺激和响应控制来观察驾驶员的错误。这个项目的参与者将是115名有合法执照的PD司机和同等数量的没有神经系统疾病的对照司机。考虑到磨损，115名PD患者中的100名将在首次驾驶评估两年后重新接受测试，以衡量PD进展对驾驶员安全的影响。我们的目标是增加对pd相关的运动功能障碍、认知障碍和白天唤醒障碍在驾驶安全错误中的作用的理解。更好地了解PD患者的驾驶性能是如何恶化的，以及驾驶员是否意识到自己的损伤，是合理开发干预措施以帮助预防PD患者撞车的必要步骤。本研究中使用的技术最终可以用于开发未来的工具，用于筛选、识别、建议和警告PD患者，他们有更大的驾驶障碍风险。公平和准确地检测不适合PD的驾驶员将有助于减轻这些受损个体造成的机动车撞车悲剧。

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.