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，但车辆碰撞造成了严重的公共卫生问题。患有帕金森病（PD）的驾驶员由于运动功能，认知和日间唤醒的进行性损伤而面临撞车的特殊风险。一些患有PD的驾驶员特别有可能在受损时驾驶，因为他们没有意识到性能受损，他们的医生也没有意识到。对患有PD的高危驾驶员是否适合驾驶的判断应依赖于对性能的经验观察，因为仅基于医疗诊断或年龄的决定可能不公平地拒绝患者的流动性或不明智地授权不适合的驾驶员获得执照。我们建议扩大现有的知识，驾驶安全的帕金森病通过测试一组假设的实验，将评估（1）运动功能，使用标准化的措施帕金森病，（2）认知功能，使用标准化的神经心理测试（注意力、知觉、记忆和执行功能），（3）白天唤醒（困倦的标准自我评定和盖子关闭的监测），和（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。我们的试点研究与PD的司机显示这种方法的可行性。模拟器可以在一个对驾驶员和测试员来说既具有挑战性又安全的环境中，通过最佳的刺激和响应控制来观察驾驶员的错误。该项目的参与者将是115名患有PD的合法驾驶员和同等数量的无神经系统疾病的对照驾驶员。考虑到损耗，这115名患有PD的驾驶员中的100名将在初始驾驶评估后两年内重新进行测试，以测量PD进展对驾驶员安全性的影响。我们的目标是增加对PD相关运动功能障碍、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PD患者的驾驶性能如何恶化，以及驾驶员是否意识到他们的损伤，这是合理制定干预措施的必要步骤，有助于预防PD患者发生撞车事故。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，建议和提醒PD驾驶员，这些驾驶员有更大的驾驶受损风险。公平和准确的手段来检测不合适的司机与PD将有助于减轻悲剧的机动车碰撞造成的这些受损的个人。

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.