Naturalistic Assessment of the Driving ability of Cognitively Impaired Elders

描述（由申请人提供）：本协议描述了研究将检查老年驾驶员的驾驶能力，这些驾驶员有或没有与可能或可能的阿尔茨海默病相关的认知障碍。这项研究将扩大我们对认知受损的老年司机的认识，并扩展我们目前在RO1#AG16335研究中所做的观察，题为“老年痴呆症危险司机的纵向研究”。具体来说，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）以及无认知障碍（N=50）的老年司机。我们将比较特定计算机测量的视觉注意力和执行功能的表现与数码相机记录的受试者在自己的汽车中，在自然环境中行驶的表现。我们将对完成罗德岛州改编自华盛顿大学道路测试的扩展版本的同一受试者进行类似的计算机测量分析。驾驶结果将根据连续评级量表以及全球安全评估进行评分。这些评估将在基线时进行，并每一年重复一次。这将是同类研究中首次在老年人自然驾驶环境中直接检查认知受损的老年人。我们将比较结构化道路测试环境中的驾驶性能与非结构化自然环境中的驾驶性能。这种比较将有助于我们了解路试作为这一人群驾驶评估的“黄金标准”的有效性。此外，我们将通过在熟悉和不熟悉的驾驶环境中使用可靠的录像评分量表来描述和量化驾驶中所犯的错误类型。我们预测，在自然环境中的视频记录将更敏感地检测驾驶员的错误。这项研究的次要目标将包括检查家庭成员和照顾者在预测由专业驾驶教练在自然和道路测试设置驾驶性能评级的准确性。与公共卫生的相关性：最终，本研究旨在开发选定的计算机化措施，作为临床医生办公室实践或机动车辆部门的筛选措施的试点测试。此外，我们还将深入了解正规道路测试与认知受损的老年驾驶员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患有早期痴呆的司机这一非常重要和令人烦恼的问题的理解，为识别那些危险驾驶风险最大的人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.