A LONGITUDINAL STUDY OF HAZARDOUS DRIVERS WITH DEMENTIA

本方案描述了一个纵向研究项目，该项目将检查阿尔茨海默病患者主动驾驶受试者的道路驾驶性能变化和{认知}变化。 众所周知，老年痴呆症是老年人发生机动车碰撞和死亡的一个危险因素。 退化性痴呆，如阿尔茨海默氏病，由于其渐进的性质，最终导致驾驶能力在所有情况下。 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放弃驾驶。由于阿尔茨海默病患者在痴呆症处于最早和最轻微的阶段时可能仍然有能力驾驶，并且由于驾驶是老年人保持自主性的重要因素，因此不应根据对记忆能力的任意决定而吊销驾驶执照。 每年为所有长者或甚至所有患有痴呆症的长者进行驾驶能力道路测试，既不实际，也不经济。 因此，迫切需要一种有效的筛选工具。 了解痴呆症患者发生的导致危险驾驶的实际驾驶障碍以及它们如何与神经心理功能随时间的变化相关，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驾驶员将参加本研究，并在{2至} 3年内每6个月进行一次随访。 最近经过验证的道路测试协议将由专业驾驶教练管理。将同时进行视觉感知、视觉注意力和执行功能的{计算机化}神经心理学测试。 据预测，驾驶障碍的最早证据将与视觉感知和注意力障碍有关。 在痴呆症的更晚期阶段，当受试者最有可能被判断为不称职的驾驶员时，执行功能也会出现明显的缺陷。这项研究的纵向设计将提供重要的见解，在AD患者的驾驶障碍的演变，并协助在未来的发展筛选测试，以确定危险的司机谁可能会失败的性能为基础的道路测试。

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.