Longitudinal Executive Changes in Drivers with Parkinson's Disease: Study Using Neuropsychological and Driving Simulator Tasks

Abstract

Background/Aims: (1) To investigate how specific executive functions change over 2 years in drivers with Parkinson's disease (PD) compared to controls, using both neuropsychological and driving simulator tasks; and (2) to explore the association between the decline of specific executive functions and changes in driving habits in PD. Methods: Sixteen PD patients and 21 controls underwent neuropsychological testing twice and performed tasks on a driving simulator, with an interval of approximately 2 years. Questions on participants' self-perception of their driving ability were administered. Results: A significant decline was observed in shift cost over time (Plus Minus Test) in patients (p = 0.008). This decline was greater in patients than in controls (p = 0.008). No significant change emerged over time in the flexibility cost of PD patients on a simulator (p = 0.158). Significant correlations were found between the decline in shift cost over time and driving question outcomes (p < 0.05). Conclusion: This study reveals a differential course of executive functions in PD. Over time, patients displayed significant decline in flexibility associated with modifications in their driving. Flexibility seems to be affected as the disease progresses. This research opens new avenues in cognitive and driving rehabilitation.

Longitudinal decline of driving safety in Parkinson disease

“…In addition to worsening of global cognition, deterioration of error counts was predicted by poor baseline visual sensory function (near visual acuity) and worsening of visual processing speed and attention, visual working memory, cognitive flexibility and set shifting, and ADL score. These predictors are consistent with the most frequent nonmotor deficits in mild to moderate PD, and reflect impairments in primary neural demands of driving (visual function across all levels and executive functions 25 ). The UPDRS-ADL score, but not the UPDRS motor score, was also an important predictor of driving cessation in our cohort, 8 suggesting a measure of function over a period of time, rather than a snapshot of severity of parkinsonism, is a better metric of decline of driving safety over time.…”

Driving with a neurodegenerative disorder: an overview of the current literature

“…A number of studies have incorporated cognitive assessments in an attempt to determine which test performances are associated with the driving competence of patients with PD. Most studies reported an association between cognitive functioning and driving competence [ 3 , 12 , 26 – 28 , 31 , 32 , 36 , 38 – 40 , 43 , 46 , 48 – 52 ]. However, some studies also reported no associations between cognition and driving in PD patients [ 1 , 33 , 53 ], so results are inconsistent.…”

“…However, some studies also reported no associations between cognition and driving in PD patients [ 1 , 33 , 53 ], so results are inconsistent. Driving errors were particularly associated with lower performances in cognitive flexibility [ 26 , 27 , 38 , 39 , 49 , 52 ], visuoconstructional abilities [ 26 , 36 , 39 ], attention [ 12 , 27 , 32 , 36 , 40 , 46 ], psychomotor speed [ 46 , 51 ], working memory [ 12 , 49 ], set shifting [ 12 , 48 ], information processing [ 12 , 49 ], contrast sensitivity [ 27 , 31 , 43 , 48 , 51 ], visual scanning [ 32 ], visual acuity [ 32 , 40 ], speed of visual processing [ 3 , 27 , 28 , 40 ], and visual memory [ 3 , 36 ].…”

Fahrkompetenz und Morbus Parkinson

“…Nicht motorische Symptome der Parkinsonkrankheit können bereits Jahre vor den motorischen Symptomen einsetzen [11,12] und mit steigender Krankheitsdauer zunehmen [13,14]. Schlechtere Leistungen in Aufmerksamkeit, der Aufnahme und Verarbeitung visueller sowie visuell-räumlicher Informationen und in Teilbereichen exekutiver Funktionen sind bei Parkinson-Patienten mit mehr Fahrfehlern und Veränderungen im Fahrverhalten assoziiert [5,9,[15][16][17]. Zusätzliche Aufgaben, z.…”

“…Zusätzliche Aufgaben, z. B. visuelles Suchen, können zu einer kognitiven Überlastung [16,18] und zu einem erhöhten Unfallrisiko führen [19]. Betrachtet man die Demenzerkrankung, ist besonders bei mittleren-schweren Ausprägungen die Fahrkompetenz beeinträchtigt [20].…”