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September 04, 2018; 91 (10) Article

Driving impairment and crash risk in Parkinson disease

A systematic review and meta-analysis

Trevor Thompson, Damian Poulter, Clare Miles, Marco Solmi, Nicola Veronese, André F. Carvalho, Brendon Stubbs, Ergun Y. Uc
First published August 3, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006132
Trevor Thompson
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Damian Poulter
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Clare Miles
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Marco Solmi
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Nicola Veronese
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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André F. Carvalho
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Brendon Stubbs
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Ergun Y. Uc
From the Faculty of Education and Health (T.T., D.P., C.M.), University of Greenwich, London, UK; Department of Neuroscience (M.S.), University of Padova; National Research Council (N.V.), Neurosciences Department, Aging Branch, Padova, Italy; Department of Psychiatry (A.F.C.), University of Toronto; Centre for Addiction & Mental Health (A.F.C.), Toronto, Canada; Physiotherapy Department (B.S.), South London and Maudsley NHS Foundation Trust, London; Department of Psychological Medicine (B.S.), King's College, De Crespigny Park, London, UK; Department of Neurology (E.Y.U.), Carver College of Medicine, University of Iowa, Iowa City; and Neurology Service (E.Y.U.), Iowa City Veterans Affairs Medical Center, IA.
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Driving impairment and crash risk in Parkinson disease
A systematic review and meta-analysis
Trevor Thompson, Damian Poulter, Clare Miles, Marco Solmi, Nicola Veronese, André F. Carvalho, Brendon Stubbs, Ergun Y. Uc
Neurology Sep 2018, 91 (10) e906-e916; DOI: 10.1212/WNL.0000000000006132

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Abstract

Objectives To provide the best possible evidence base for guiding driving decisions in Parkinson disease (PD), we performed a meta-analysis comparing patients with PD to healthy controls (HCs) on naturalistic, on-the-road, and simulator driving outcomes.

Methods Seven major databases were systematically searched (to January 2018) for studies comparing patients with PD to HCs on overall driving performance, with data analyzed using random-effects meta-analysis.

Results Fifty studies comprising 5,410 participants (PD = 1,955, HC = 3,455) met eligibility criteria. Analysis found the odds of on-the-road test failure were 6.16 (95% confidence interval [CI] 3.79–10.03) times higher and the odds of simulator crashes 2.63 (95% CI 1.64–4.22) times higher for people with PD, with poorer overall driving ratings also observed (standardized mean differences from 0.50 to 0.67). However, self-reported real-life crash involvement did not differ between people with PD and HCs (odds ratio = 0.84, 95% CI 0.57–1.23, p = 0.38). Findings remained unchanged after accounting for any differences in age, sex, and driving exposure, and no moderating influence of disease severity was found.

Conclusions Our findings provide persuasive evidence for substantive driving impairment in PD, but offer little support for mandated PD-specific relicensure based on self-reported crash data alone, and highlight the need for objective measures of crash involvement.

Glossary

CI=
confidence interval;
HC=
healthy control;
OR=
odds ratio;
OTR=
on-the-road;
PD=
Parkinson disease;
PRISMA=
Preferred Reporting Items for Systematic Reviews and Meta-Analyses;
SMD=
standardized mean difference;
UPDRS-III=
Unified Parkinson's Disease Rating Scale, Part III

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received March 9, 2018.
  • Accepted in final form June 8, 2018.
  • © 2018 American Academy of Neurology
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