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Abstract
Objective: To develop an efficient clinical screening battery to accurately predict the fitness to drive in people with Parkinson disease (PD).
Methods: This prospective study included 80 participants: 40 patients with PD and 40 healthy age- and sex-matched control subjects. All participants were assessed using a driving simulator, a driving history survey, and the Clinical Dementia Rating. The patients with PD also underwent a clinical test battery and an evaluation of fitness to drive performed by an official center, which included visual, cognitive, and on-road tests. A two-class decision from this driving assessment center was the main outcome measure.
Results: A screening battery assessing four clinical variables (disease duration, contrast sensitivity, Clinical Dementia Rating, and motor part of the Unified Parkinson’s Disease Rating Scale) provided the best model (R2 = 0.52) to predict the fitness to drive and correctly classified 36 (90%) of the patients with PD as pass or fail (sensitivity = 91%, specificity = 90%). The Test Ride for Investigating Practical fitness to drive (TRIP) driving simulator score discriminated significantly between drivers with PD and their healthy peers (p = 0.0008). When the TRIP driving simulator score was added to the clinical model, the total explained variance increased (R2 = 0.60) and correctly classified 39 (97.5%) of drivers with PD into the pass/fail category (sensitivity = 91%, specificity = 100%).
Conclusions: A short clinical screening battery that measures disease duration, contrast sensitivity, cognitive and motor functions can predict fitness to drive in people with Parkinson disease with a high degree of accuracy.
GLOSSARY: ADL = activities of daily living; CDR = Clinical Dementia Rating; CS = contrast sensitivity; DBS = deep brain stimulator; ESS = Epworth Sleepiness Scale; IQR = interquartile range (Q1–Q3); NA = not applicable; PD = Parkinson disease; rb = biserial correlation coefficient; rrb = rank biserial correlation coefficient; rs = Spearman rank correlation coefficient; TRIP = Test Ride for Investigating Practical fitness to drive; UFOV = useful field of view; UPDRS II = Unified Parkinson’s Disease Rating Scale, activities of daily living; UPDRS III = Unified Parkinson’s Disease Rating Scale, motor scale; w = Wilcoxon rank sum test.
Footnotes
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Hannes.Devos{at}faber.kuleuven.be
Funded by a grant from the Nationale Vereniging voor Steun aan Gehandicapten and DVV insurances of Belgium. W.V. is a Senior Clinical Investigator of the Fund for Scientific Research–Flanders.
Disclosure: The authors report no conflicts of interest.
Received February 14, 2007. Accepted in final form April 27, 2007.
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