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PubMed1999

[Assessment of cognitive suitability to drive after brain injury].

There is an increasing interest in methods for assessing fitness to hold a driver's licence among patients with traumatic brain injury, cerebrovascular accidents and other central nervous system diseases which present cognitive impairments. This article describes a multimodal approach including medical, neuropsychological and open-road evaluations. We also present a study of 135 patients with cognitive deficits, 29 females and 106 males, mean age 48. Data from neuropsychological assessments are compared to scores on the Mini Mental State Examination and to results from the open-road tests. We recommend that patients with Mini Mental State scores > 20 are referred for further neuropsychological assessments, while patients with scores < 20 are usually unfit for driving. We regard the Mini Mental State Examination as unsuited for patients with aphasia. Our recommendation is that patients who present a complicated picture are referred to regional interdisciplinary centres.

Adolescent↗
PubMed1977

[Drivers license qualification for epileptics].

The question whether a person with epilepsy qualified for a driving licence must be examined from the point of view of the individual as well as that of the community. The general public should be protected against unduly high risks from epileptic drivers, whereas the patient has a right to live as normal a life as possible, which includes driving an automobile. Too rigid criteria for obtaining the license increase the number of persons who evade medical control and drive "illegally". To require physicians to report their epileptic patients to the authorities would be counterproductive; it would also destroy the personal confidence between physician and patient which is so essential for successful treatment. Epileptic persons endanger safety on the road only slightly: 0.1-0.3% of all traffic accidents are due to epileptic seizures. In contrast, abuse of alcohol plays a major role in 6-9% of all accidents, whereas 80-90% are attributable to evident mistakes by the driver. Epileptic patients under regular medical supervision who are licenced on grounds of approved criteria do not cause more accidents than the general population. A dangerous group are, however, those with mental alterations (organic or reactive) and particularly patients with aggressive and expansive-compensatory traits, as well as those driving without permission. Prognostic criteria as to the further course of the disease are paramount for the assessment of qualification for the licence. The following rules have proved their worth: 2 years freedom from seizures (with or without therapy), no abnormalities specific for epilepsy in the EEG, no serious mental changes, regular medical supervision and treatment mus be guaranteed. Departures from these rules should be confined to exceptional cases with the consent of a physician specialized in epileptology. The same holds for admission to higher categories of driving licence, the only practical eventuality being category D (lorries), and even this only in rare cases. It will scarcely ever be possibel to licence a person who has at some time had epilepsy for professional passanger transportation. The attitude of the physician who first sees the seizure patient is often decisive. It is important that he recognizes the problem, objectively informs his patient and from the very outset gives him realistic advice in order to avoid false decisions, particularly regarding his professional career.

Accident Prevention↗
PubMedDate not supplied

[Age limits for drivers' licenses].

German traffic laws do not include a limit for senior holders of driver's licenses or an obligatory medical examination. Introduce of such limits or measures is not advocated. Scruples exist against the offers of public traffic establishments to exchange the driver licence for a free ticket (valuable one year).

Accidents, Traffic↗
PubMed2003

[Driving capacity and antidepressive drugs].

OBJECTIVE: The aim of our study was to investigate the influence of antidepressants on psychomotor function related to car driving abilities. METHOD: Depressive inpatients (n = 64) were investigated under steady state plasma level conditions. Data were collected with the ART 90 (Act and React Testsystem) measuring visual perception, reactivity, stress tolerance, selective attention and vigilance and were analyzed according to medication, severity of illness and age. RESULTS: Only 23.8% of the sample reached the criteria of at least 15% of normal controls performance. We also observed that treatment with newer antidepressants (n = 31) was altogether associated with a better performance than treatment with tricyclics (n = 33). CONCLUSIONS: These findings have important implications for a systematic examination of driving ability in depressive patients and data show that newer antidepressants may have more salutary effects on psychomotor function than tricyclic antidepressants.

Adult↗
PubMed2001

Driving and dementia: a review of the literature.

In North American society driving is closely linked with independence. Unfortunately, the freedom to operate a motor vehicle may be lost when an individual develops a specific medical diagnosis. The complex issue of dementia and driving safety is frequently encountered by health care professionals. Physicians are required, by law, to report any medical diagnosis such as dementia, that may affect driving safety. Physicians often refer to occupational therapists to assist them in determining if an individual's impairment significantly impacts driving safety. Unfortunately many health care professionals are not using reliable, valid and sensitive tests to determine the point at which an individual with dementia will become an unsafe driver. Through a review of the literature, the authors explore the effects of normal aging and cognitive impairment on driving safety. Specific assessment tools used to assess driving ability are examined and the role of health professionals in driver assessment is discussed. Some suggestions to improve the overall approach to evaluating driving safety are offered in the conclusion.

Aged↗
PubMed2000

Motorist vision policy.

BACKGROUND: The primary purpose of public policy requiring vision testing for driver license renewal is to identify individuals with functional vision impairments and, when necessary, to restrict their driving. This is based on the presumption that poor vision is causally related to poor driving and traffic crashes. METHODS: The AOA Environmental and Occupational Vision Committee performed a synthesis of relevant empirical literature on policy-based research and developed potential options for enhancing traffic safety. RESULTS: Presently, some states require vision testing for driver's license renewal and some do not. Regional and nationwide studies report that vision-related license renewal policies are associated with enhanced traffic safety. However, contemporary vision screening tests may be of limited value in identifying individuals with functional vision impairments. CONCLUSION: The most cost-effective and valid method for identifying, treating and counseling visually impaired drivers is to require a comprehensive eye examination as a condition for driver license renewal for those with a high prevalence or high probability of vision impairment.

Accidents, Traffic↗
PubMedDate not supplied

To drive or not to drive: preliminary results from road testing of patients with dementia.

There has been considerable debate about whether driving privileges should be revoked from patients with a diagnosis of dementia and whether highway safety policies should come under closer scrutiny for all elderly. Two case studies are reported of patients with a diagnosis of probable Alzheimer's disease who participated in a pilot project to assess driving. Subjects underwent neurologic and neuropsychological evaluation. Caregivers were included in psychosocial assessments. Patients participated in a specially designed driving evaluation, including an actual road test. Although both patients had mild-to-moderate cognitive impairment on standard tests, one of the patients was deemed safe to drive on the road test while the other was not. These preliminary results suggest that driving skill may not be predictable solely on the basis of the office examination. A road competency test provides a more objective and direct measure on which to base a decision of such important consequence. Implications for public policy and the role for healthcare providers in this process are discussed.

Aged↗
PubMed1991

A survey of the visual acuity of Brisbane drivers.

OBJECTIVE: To conduct a survey of the visual acuity of a group of Brisbane Drivers. SETTING: The outpatient department of the Princess Alexandra Hospital, Brisbane. PARTICIPANTS: Five hundred and three subjects drawn from patients, visitors and staff attending the outpatient department on 10 working days from December 5 to December 16, 1988. MAIN OUTCOME MEASURES: Subjects' age, driver's licence details and driving history were gathered by questionnaire. Visual acuity was assessed with the aid of a Snellen chart. RESULTS: Nearly 6% of the survey group had visual acuity worse than 6/12; 15% had never had their eyes tested other than for licensing purposes; 21% stated that their last ophthalmic or optometric examination was more than five years previously; and 8% failed to meet the Queensland visual acuity requirements for their class of licence. CONCLUSIONS: The monocular driver is not detected by current licence testing procedures in Queensland. Many licence holders do not meet the present visual acuity criteria of the Queensland Department of Transport.

Accidents, Traffic↗
PubMed1994

Health assessment for commercial driving. The general practitioners' role.

Death and injury rates associated with commercial vehicle driving are unacceptably high. Pre-existing medical conditions may contribute to road accidents and the National Road Transport Commission (NRTC) has developed a set of uniform guidelines, based on best available evidence, which might preclude at risk individuals from holding commercial licences. Standardised clinical examinations performed by general practitioners (GPs) will be used to assist regulatory authorities in their licensing procedures. This article sets out the process of development of the guidelines as well as the construction and use of a medical assessment form to be used by GPs in facilitating the licensing process in each State.

Accidents, Occupational↗
PubMed2001

Neuropsychological aspects of driving characteristics.

Brain injury often causes impairments of cognitive functions, which may affect driving performance. The question of whether the brain-injured patient can resume car driving or not generally comes up during rehabilitation. The medical clinical examination, covering neurological status, screening of cognitive functions, and affective state, is insufficient in assessing relevant functions required for driving performance. A neuropsychological assessment and a driving test are additional parts of the driving assessment besides the medical examination. In this paper, neuropsychological test results and driving test results from four patients with brain injury are presented. The paper demonstrates the complementary value of neuropsychological assessment and a driving test: the relevance of cognitive factors for interpretation of driving problems, but also the relevance of a driving test to show compensatory capacity in some drivers with brain injury. Thus, collaboration between medical, neuropsychological and driving expertise can promote and deepen the total assessment of driving performance after brain injury.

Aged↗
PubMed2003

Changes in collision rates among novice drivers during the first months of driving.

As a group, young drivers have crash rates that far exceed those of older, experienced drivers. But even among teenagers there are age-related differences; crash rates decline consistently and dramatically with each yearly increase in age. A more precise understanding of how crash rates decline within the teenage group might provide insights into when experience is most influential. To address this issue, this study examines month-to-month changes in collisions among new drivers. It was found that crash rates drop most dramatically during the first 6 months of driving. Involvement in certain types of crashes-e.g. run-off-the-road, single-vehicle, night, weekend-declines more rapidly. The findings suggest that novices improve their driving in a relatively short period of time. A graduated driver licensing system is identified as an effective method for ensuring that this development takes place in a more forgiving environment.

Accidents, Traffic↗
PubMed1990

[Regulation for medical-psychologic examination of drunk drivers].

The author gives some further arguments for the truth of the critical review by Müller on the present legal situation of the medical-psychological examination of first-time drunken drivers by order (Blutalkohol 27, 116). He demands: Every person who applies for a driver's licence and whose former driving licence has been withdrawn should (after a screening of his person) be obliged to present a short expert opinion by a medical-psychological examination department, which gives hints on the further procedure before he is permitted to get a new driver's licence. The same procedure should be in force for persons who apply for a driver's licence on probation, if their former driving licence on probation has been withdrawn. Post-schooling, which is included in the law on driving licences, should not be carried through, if it is evidently hopeless. A certification on the participation in post-schooling course within the scope of the driver's licence on probation should not be given, if the aims of the course are evidently not within reach.

Accidents, Traffic↗
PubMed2000

Relationship of laboratory and on-road tests for driving-school students and experienced drivers.

There is a pressing need to evaluate driving ability without an actual driving test but no reliable, standardised procedure is available. This study investigated the resulting distortion performance evaluation for different driver groups in on-road tests due to driving skills and driving style. Two groups, 15 female driving school students and 25 experienced male drivers were examined using cognitive and psychomotor tests and standard personality questionnaires as well as an on-road driving test. The students made significantly fewer errors on the driving test than the experienced drivers. The former group's driving performance could be predicted by errors on the laboratory tests, along with personality factors, while experienced drivers' driving errors were best predicted by slowness on laboratory tests. This study suggests that, when a series of standard cognitive and psychomotor tests are considered, different measures may apply in predicting young people's ability to drive safely based on assessing driving ability of experienced drivers, assumed lowered due to distorted driving style.

Adolescent↗
PubMed1998

On-road assessment of driving competence after brain impairment: review of current practice and recommendations for a standardized examination.

OBJECTIVE: To examine the approaches to on-road assessment of driver competence in persons with brain impairment. Items examined were procedures, standardization, scoring methods, equipment requirements, and determination of fitness to drive. DATA SOURCES: All studies identified through citation or Medline search. STUDY SELECTION: The studies reviewed were those published from 1971 to the present that examined driving competence after brain impairment, as measured by a driving test. DATA EXTRACTION: A qualitative review of published studies reporting methodologies and authors' conclusions abstracted from sourced publications. DATA SYNTHESIS: Off-road driving assessments examine proficiency in operating a motor vehicle, but not ability to drive in traffic or accurate prediction of safe driving. On-road driving assessments have been used to examine the predictive validity of other driving assessment methods or the driving performance of subjects with brain impairment. Determining a subject's competence to drive is frequently a subjective evaluation. With a standardized driving test, a significant correlation between the objective driving score and the rater's global evaluation of fitness has been reported. CONCLUSION: Closed-course, off-road driving tests are recommended for examining vehicle operation skills and readiness for in-traffic evaluation only. This allows practice with any vehicle adaptations before on-road evaluation and identification of clients who are unsafe to proceed on-road. A practical driving test in traffic, with standardized route and driving maneuvers, is recommended for determining driver competence. Scoring of driving performance should be standardized, reliable, and specific, to identify deficient driving skills that may be amenable to training. Driving performance should be evaluated according to predefined criteria, and the judgment regarding competence should be closely related to this objective measure.

Automobile Driver Examination↗
PubMed2006

Effect of a concurrent task on driving performance in people with Parkinson's disease.

Numerous studies previously have reported reduced driving performance in people with Parkinson's disease (PD). Few studies to date, however, have examined how specific cognitive difficulties associated with PD impact on specific aspects of driving performance in this population. In this study, the impact of a concurrent task on driving performance was examined. A simulator was used to measure the driving behavior of 18 current drivers with PD and 18 matched controls. The presence of a concurrent task was manipulated between conditions. Results showed that, although groups were similarly affected by the concurrent task on most driving measures, participants with PD were disproportionately affected on operational level driving behavior. It also appears that participants with PD sacrificed concurrent task performance to maintain driving performance. These results further support the hypothesis that cognitive difficulties associated with PD compromise driving performance in this population, even in the mild to moderate stages of the disease.

Aged↗
PubMed2001

[Cognitive impairments among older drivers: medical examination and driving test].

The aim of this study was to gain insight in the prevalence of cognitive impairments among active older drivers and in driving performance of cognitively impaired ones. The study was implemented in the existing Dutch relicensing procedure for older drivers and consisted of three evaluation moments: a medical screening (for all subjects), a neuropsychological assessment and a test-drive (for candidates with cognitive impairments). In total, 2992 drivers were medically evaluated. In 4% of cases indications for impaired cognitive functioning were observed that could be evaluated and confirmed with neuropsychological tests. Eighty subjects performed an on-road test. Of these subjects, 57% were allowed to renew their driver's license, while in the remaining 43% no new licenses or restricted licenses were issued. During the test-drive, slow reactions and attention deficits were the most important causes for impaired fitness to drive.

Age Factors↗
PubMed2005

Prevention of traffic accidents: the assessment of perceptual-motor alterations before obtaining a driving license. A longitudinal study of the first years of driving.

UNLABELLED: A longitudinal study was designed with two objectives: first, to provide a wide cognitive, personality and social description of new drivers before they started to drive cars. Second, to examine the relationship between cognitive and other characteristics drivers had before obtaining their driving license and the number and type of accidents they were involved in during the first years as drivers. RESEARCH DESIGN: The longitudinal study started in 1997 and ended in 2002. The first assessment was made up of 241 individuals at the time they enrolled on the driving course. The follow-up evaluation in the year 2002 was carried out on 144 components of the initial sample after five years driving. Age, gender and education level were matched to represent the population of Spain. METHOD AND PROCEDURES: Participants were assessed with the Bender Test for visual-motor ability, the B101 Test for practical intelligence, the B19 Test for visual-motor bi-manual coordination, and the TKK-1108 for speed anticipation. Personality was also evaluated with the Rorschach test and the PSY (Psychological Assessment Questionnaire). Five years later, a new examination of all those variables was made as well as a structured interview with each participant in order to collect data relating to significant life events during that time, driving habits, opinions in relation to certain traffic rules and information on accidents, incidents and/or sanctions. MAIN OUTCOMES AND RESULTS: Serious and/or minor accidents are concentrated on a few drivers. Accidentality is not related to gender or age, but educational level is related to serious accidents. The number of accidents (severe or minor ones) cannot be predicted if considered as a continuous variable, but it is possible if considered as a discrete variable. In this case two different cognitive profiles account for the number and type of accidents. CONCLUSION: The number and type of accidents during their first years of driving are related to the cognitive profiles of drivers assessed before they obtained their driving license.

Accidents, Traffic↗