Naturalistic Assessment of the Driving ability of Cognitively Impaired Elders

描述(由申请人提供)：本协议描述了一项研究，该研究将检查患有和不患有与可能或可能的阿尔茨海默病相关的认知障碍的老年司机的驾驶能力。这项研究将扩大我们对认知受损的老年司机的了解，并扩展我们在RO1#AG16335中所做的当前研究中的观察结果，该研究题为“患有痴呆症的危险司机的纵向研究”。具体地说，我们将检查150名患有轻度阿尔茨海默病(N=50)、可疑或轻度痴呆症(N=50)、没有认知障碍(N=50)的老年司机。我们将把视觉注意力和执行功能的特定计算机测量指标的表现与数码相机记录的受试者在他们自己的汽车中、在他们的自然环境中驾驶的表现进行比较。我们将对相同受试者的计算机化测量进行类似的分析，完成华盛顿大学路考罗德岛改编版的扩展版本。驾驶结果将在连续评级量表和全球安全评估中进行评分。这些评估将在基线上进行，并在一年内重复。这将是第一项在自然驾驶环境中直接检查认知受损老年人的同类研究。我们将比较结构化道路测试环境中的驾驶性能和非结构化自然环境中的性能。这一比较将有助于我们理解路考作为驾驶评估在这一人群中的“黄金标准”的有效性。此外，我们将通过使用在熟悉和不熟悉的驾驶环境下的视频记录的可靠评级量表，来表征和量化在驾驶中犯下的错误类型。我们预测，自然环境中的视频记录将对检测驾驶员错误更加敏感。这项研究的次要目标将包括检查家庭成员和照顾者在自然和路考环境下由专业驾驶教练预测驾驶表现评级的准确性。与公众健康的相关性：最终，这项研究寻求开发选定的计算机化测试方法，作为临床医生办公室实践或机动车部门的筛查措施进行试点测试。此外，我们还将获得亟需的洞察，了解认知受损的老年司机的正式道路测试与实际日常驾驶表现的相关性。通过这种方式，从纵向研究中获得的知识将进一步促进我们对早期痴呆症司机这一非常重要和令人烦恼的问题的理解，从而为识别危险驾驶的最大风险人群提供一些潜在的解决方案。

DESCRIPTION (provided by applicant): This protocol describes research that will examine the driving abilities of elderly drivers with and without cognitive impairment related to probable or possible Alzheimer's disease. This research will expand our knowledge about cognitively impaired older drivers and extend the observations made during our present research studies from RO1#AG16335, entitled "A Longitudinal Study of Hazardous Drivers With Dementia." Specifically, we will examine 150 older drivers with mild Alzheimer's disease (N=50), questionable or mild dementia (N=50), and no cognitive impairment (N=50). We will compare performance on specific computerized measures of visual attention and executive function to digital camera recordings of subjects in their own cars, driving in their natural environments. We will perform a similar analysis of the computerized measures for the same subjects completing an extended version of the Rhode Island adaptation of the Washington University Road Test. Driving outcomes will be scored on continuous rating scales as well as global assessments of safety. These assessments will be done at baseline and repeated at one year. This will be the first study of its kind to directly examine cognitively impaired elders in their natural driving environments. We will compare driving performance in the structured road test setting to performance in the unstructured natural setting. This comparison will help us to understand the validity of the road test as a "gold standard" for driving assessment in this population. Furthermore, we will characterize and quantify the types of errors made in driving, by use of a reliable rating scale of the video recordings in both familiar and unfamiliar driving environments. We predict that video recordings in the natural environment will be more sensitive for detection of driver errors. Secondary goals of this research will include examination of the accuracy of family members and caregivers in predicting driving performance ratings by a professional driving instructor in the natural and road test settings. Relevance to public health: Ultimately, this research seeks to develop selected computerized measures for pilot testing as a screening measure in the clinician's office practice or in a department of motor vehicles. Also, we will gain much needed insight into the relevance of formal road tests to actual day to day driving performance by cognitively impaired older drivers. In this way, knowledge gained from the longitudinal study will further advance our understanding of the very important and vexing problem of drivers with early dementia, producing some potential solution to the identification of those at greatest risk for hazardous driving.