A LONGITUDINAL STUDY OF HAZARDOUS DRIVERS WITH DEMENTIA

本协议描述了一个纵向研究项目，该项目将检查患有阿尔茨海默病的积极驾驶受试者的道路驾驶表现变化和{认知}变化。众所周知，痴呆症是老年人发生机动车碰撞和死亡的一个危险因素。退行性痴呆，如阿尔茨海默病，由于其进行性，最终在所有情况下都会导致驾驶能力下降。临床医生在日常实践中面临的一个关键问题是，何时建议早期疾病患者不要开车。因为阿尔茨海默病患者如果处于早期和最轻微的痴呆阶段，可能仍然有能力驾驶，而且因为驾驶是保持老年人自主性的一个重要因素，所以不应该基于对一个人记忆能力的武断决定而吊销执照。每年对所有老年人甚至所有老年痴呆症患者进行道路驾驶能力测试既不实际也不经济。因此，迫切需要一种有效的筛选仪器。了解痴呆患者导致危险驾驶的实际驾驶障碍，以及它们与神经心理功能随时间变化的关系，对于开发有效的筛查工具至关重要。患有早期阿尔茨海默病的司机将被纳入这项研究，并在两到三年的时间里每六个月随访一次。由专业驾驶教练执行最近验证的道路测试协议。视觉感知、视觉注意和执行功能的神经心理测试将同时进行。据预测，驾驶障碍的最早迹象将与视觉感知和注意力障碍有关。在痴呆症的晚期，当受试者最有可能被判定为不称职的司机时，执行功能也会出现明显的缺陷。本研究的纵向设计将为阿尔茨海默病患者驾驶障碍的演变提供重要的见解，并有助于未来筛查测试的发展，以识别可能无法通过基于性能的道路测试的危险驾驶员。

This protocol describes a longitudinal research project which will examine changes in on-road driving performance and changes in {cognition} among actively driving subjects with Alzheimer's disease. It is well recognized that dementia is a risk factor among the elderly for motor vehicle crashes and fatalities. Degenerative dementias such as Alzheimer's disease, because of their progressive nature, eventually lead to driving incompetence in all cases. A critical question that faces clinicians in everyday practice is when to advise patients with early disease to abstain from driving. Because patients with Alzheimer's disease may still be competent to drive if their dementia is in its earliest and mildest stage, and because driving is an important factor in maintaining autonomy for elders, licenses should not be revoked based on arbitrary decisions about one's memory ability. Annual road testing for driving competence of all elders or even all elders with dementia is neither practical nor economical. Therefore, an effective screening instrument is badly needed. Knowledge about the actual driving impairments that occur in dementia patients that lead to hazardous driving and how they relate to changes in neuropsychological function over time is critical to the development of a valid screening tool. Drivers with early stage Alzheimer's disease will be enrolled in this study and followed every six months over {two to} three years. A recently validated road test protocol will be administered by a professional driving instructor. {Computerized} neuropsychological tests of visual perception, visual attention, and executive function will be administered concurrently. It is predicted that the earliest evidence of driving impairment will be associated with disturbances {in visual perception and attention.} In more advanced stages of dementia, when subjects are most likely to be judged as incompetent drivers, there will be prominent deficits in executive function as well. The longitudinal design of this study will give important insights into the evolution of driving impairment among AD patients and assist in the future development of screening tests to identify hazardous drivers who would be likely to fail a performance based road test.