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PubMed2005

[Automobile driving among patients with dementia. Survey in the Poitou-Charentes region].

OBJECTIVES: To determine the characteristics of drivers with dementia and analyze their driving habits. METHODS: The study was conducted among neurologists and geriatricians in the Poitou-Charentes region. We asked 75 physicians to question (according to a structured questionnaire) the patients they saw in January 2004 who were known to suffer from dementia, defined by a Folstein Mini-Mental State (MMS) score pound 25. We compared the epidemiologic characteristics of drivers and nondrivers and described their driving habits. RESULTS: Of the 75 practitioners asked to participate, 27 (36%) accepted and interviewed 146 patients, 74 women and 72 men. Their mean MMS score was 17.6 +/- 5.6 [0-25]. In all, 52 were still driving at the time of the interview, and 48 had stopped, 9 because of motor vehicle accidents. Logistic regression analysis revealed 3 significant variables that differed between the drivers and the nondrivers: drivers were mainly male (p=0.0002), younger (p=0.001) and more recently diagnosed (p=0.003). Half those still driving drove only occasionally (< or =3 times a week), usually during daylight and for short distances. One driver was involved in an accident the year before. DISCUSSION: Patients appeared to be aware of the dangers of driving and avoided taking risks. The MMS score predicted driving status. It is essential to develop simple tests to assess driving ability as objectively as possible.

Accidents, Traffic↗
PubMed1995

A polysomnographically documented case of adult somnambulism with long-distance automobile driving and frequent nocturnal violence: parasomnia with continuing danger as a noninsane automatism?

A case of childhood-onset somnambulism is reported in which a 43-year-old man presented with repeated sleep-related injuries incurred during violent nocturnal activity, which included frenzied running, throwing punches and wielding knives. He had also driven an automobile a long distance during a presumed somnambulistic state. His wife had been repeatedly injured, and she felt that her life was threatened by his nocturnal violence 2-3 times yearly. Polysomnography (PSG) documented multiple episodes of complex and violent behaviors arising exclusively from stage 3/4 sleep, thus confirming the diagnosis of somnambulism. Other causes of sleep-related violence were excluded. The patient responded promptly to treatment with bedtime clonazepam, and benefit was maintained at 5-year follow-up. Although this strictly clinical case did not have any legal repercussions, it does carry forensic implications, particularly when placed in the context of the published medical literature on PSG-documented parasomnias (somnambulism, rapid eye movement sleep behavior disorder) containing explicit examples of recurrent violence, at times life-threatening, directed toward the bed partner and others. Thus, a new medical-legal concept is proposed, consisting of "parasomnia with continuing danger" as a noninsane automatism. Treatment guidelines, within the context of forensic medicine, are presented.

Adult↗
PubMed1990

[Arrhythmias during automobile driving in patients after acute myocardial infarction].

In 90 patients after acute whole-thickness myocardial infarction suffered 3-48 months earlier 24-hour ECG recording was done for assessment of arrhythmias occurring while they were driving cars and for their comparison with the remaining recording hours. In most patients driving cars episodes of sinus tachycardia even up to 130/min were noted, in about half the patients some increase occurred in the frequency of ventricular ectopic beats, in two patients double and in one patient triple ectopic beats (salvoes) appeared, although they had not been recorded when the patients were not driving cars. The study was carried out (and is still continued) in autumn-winter, when the conditions of car driving were worse. None of the patients was in a collision-threatening situation which could increase dangerous arrhythmias.

Aged↗
PubMed1993

[Empirical studies of automobile driving fitness of patients treated with methadone-substitution].

The aim of this experimental study was to gain an impression on the driver fitness of heroin addicts which were at the moment substituted by methadone especially within a methadone program sponsored by the government of NRW. 21 out of 34 patients investigated were unfit to drive because they were at the time the tests were conducted under the effect of at least one additional psychotropic substance other than methadone or because at prior blood tests within 3 months they had been found at least twice under the effect of psychotropic drugs or they were known as concomitant drug users. The remaining 13 methadone patients were matched with 13 control subjects of the same sex, education and-within a range of +/- 2 years-also the same age. Testing short term memory, tracking, decision and reaction behavior, perception, sustained attention, speed estimation, peripheral attention with simultaneous central task, reactive loading, personality questionnaires including traffic specific questions and psychopathologic characteristics the patients yielded significant poorer results compared with the control group. When selecting 6 very good patients according to the decision of the physicians the significant differences concerning performance measures vanished but some differences concerning personality traits still remained. The results confirm the expert's opinion-called "disease and motor traffic"-that in general methadone substituted patients are unfit to drive. The driver fitness of the very few optimal patients depends on the amount of the personality disorders.

Adult↗
PubMed1999

[Automobile driving capacity after retinal detachment surgery].

BACKGROUND: After vitreoretinal surgery the patient is at least temporarily unable to drive. Buckling procedures may cause refractive changes, reduced motility or impaired binocular vision. We examined the ability of these patients to drive a car according to German law after retinal surgery. PATIENTS AND METHODS: The frequency and extent of changes interfering with driving ability were examined in 112 unselected patients 3.5 years (2-5 years) after successful buckling procedures. We used half-round buckling elements of 3-11 mm diameter or encircling bands (2-3 mm). We examined visual acuity, frequency of permanent diplopia and field of normal binocular vision. Driving ability was considered as impaired, when visual acuity was below 0.4 in the better eye or 0.2 in the worse eye, or when diplopia occurred within a gazing field of 20 degrees of diameter. RESULTS: Eighteen of 112 (16%) patients reported diplopia within the first 3 months, so they were temporarily unable to drive. Two to five years later 14 of 112 patients did not have sufficient visual acuity according to the German requirements. Another 2 patients had an impaired binocular vision, resulting in driving disability. CONCLUSION: Driving ability may be temporarily restricted by double vision in 15% of patients after successful buckling for retinal detachment. Permanent driving ability is mainly impaired by macular involvement in retinal detachment. The type of buckling procedure is of minor importance.

Adult↗
PubMed1987

[Fitness for automobile driving of physically handicapped patients].

Some 30.5 million Germans hold a driving license. For the person with a physical handicap, too, active traffic participation is of special importance, in that it constitutes an essential link in his rehabilitation. Road traffic authorities, in view of traffic safety, are held to consider both, the handicapped individual's interest in obtaining a license and society's claim to safety. Numerous studies have established the fact that disabled drivers, in particular those with impairment of the limbs, are neither more accident-prone nor otherwise more conspicious in road traffic than the non-disabled. The view that the driver with a physical disability poses particular risks, has been invalidated by extensive factual data and thorough literature review. Diseases of major relevance for driving ability are touched on, the range of adaptive equipment is exemplified. Physicians in accident surgery primarily have to deal with trauma to the spinal cord and limbs. The majority of these conditions permit good compensation by technical devices, enabling safe driving of a private car. Awareness of legal/administrative aspects of licensing, as well as of the adaptive potential of technical aids are of great importance to both physician and client.

Accidents, Traffic↗
PubMed1993

[Visual acuity and automobile driving fitness in the elderly].

BASIC REMARKS: Both physiological age-related degeneration of the organ of sight and its adnexa, and pathological age-related diseases, such as cataract, glaucoma or senile macula degeneration, impair a person's eyesight. MAJOR POINTS DISCUSSED: The consequences include a decrease in visual acuity, impairment of the visual field, diminishment of dark adaptation, twilight vision, contrast perception, and stereoscopic vision, together with a dramatic increase in sensitivity to light. All these phenomena may greatly reduce the elderly person's ability to cope with the demands made by modern traffic. Our investigations do, however, indicate that in parallel with increasing life expectancy, the physiological and pathological age-related changes in the organ of sight may be occurring later than formerly. Moreover, modern surgical techniques, for example senile cataract with implantation of an intraocular lens, may achieve optical rehabilitation. CONCLUSION: Active participation of the elderly in road traffic, for example driving a car, is certainly possible from the point of view of the ophthalmologist. Nevertheless, the introduction of regular testing of vision from the age of 65 onwards is to be recommended.

Accidents, Traffic↗
PubMedDate not supplied

[Monophthalmia and automobile driving].

The estimation of the visual abilities of monophtalmic patients must be done individually and the driving licence must be released only after careful consideration of all the anatomo-functional aspects of the eye in connection with the functional state of the nervous system. For releasing the driving licence to monophthalmic patients are proposed to be done: the determination of the kinetical visual acuity, the exam of the stereoscopic vision and the effectuation of some psychological tests by the ophthalmologist.

Accidents, Traffic↗
PubMed2000

[Automobile driving after a brain injury].

BACKGROUND: Little is known about driving fitness after brain damage. MATERIAL AND METHODS: The present study describes 62 brain injured patients, 36 with cerebral vascular accidents, 15 with traumatic brain injuries, and 11 with other neurological diseases, mean age 50 years, who after thorough assessment had been found fit enough for driving a car. 15 months later they were sent a questionnaire about their driving behaviour and skills. RESULTS: A higher number of traffic incidents were found after brain injury, but the difference was not significant. Patients with traumatic brain injury had a significantly higher number of traffic incidents post-injury than patients with stroke. A majority of those involved in incidents were young males with traumatic brain injury, who had deficits in cognitive executive functions. INTERPRETATION: Patients with traumatic brain injuries seem to need special attention when assessed for driving. Time to follow-up is too short for the results to be conclusive for the whole material of brain-injured patients. Further studies should be conducted.

Adult↗
PubMed1975

[Double blind study on the effects of automobile driving with automatic and standard transmission on various physiological parameters].

The main factors studied were the overall energy output and, in particular, the effects on the respiratory, cardiac and circulatory systems. The basic result was to demonstrate that while driving there occur more or less marked physiological modifications to these systems, which can be determined as to quantity; it seems clear that during particularly difficult conditions at the wheel or in subjects whose health is less than perfect, this can go as far as pathological situations. The values of catecholamines and their metabolites in the blood and urine were chosen as evaluation parameters. Catecholamines--that is, adrenaline, noradrenaline and dopamine--are substances produced by the adrenal glands; they play an essential part in the "functioning" of the sympathetic nervous system (which has important tasks, such as that of regulating the organism's equilibrium especially in reactions to sudden events or emergency situations) and are a reliable indication of effort and stress. Their action is seen in stimulation of the nervous system, cardiac agitation, an increase in blood pressure and in the production of lactic acid, increases in the basal metabolism, and so on. An excessive amount of these substances in the blood can cause real damage, above all to the heart and brain, especially in organs already affected in some way. The subjects studied were healthy volunteers, ranging in age between 20 and 35 and of comparable height and weight. A sort of "cross-over" experiment was carried out, so that the same subject was first studied driving with one type of gear change and then, two days later, was studied in the same experimental conditions but driving a vehicle with the other type of gear change. Analysis of the blood and urine sample was carried out in "single blind-test" conditions, in the sense that the research worker did not know where the samples came from. The biochemical analyses of the blood were: 1) Gas-analysis; 2) Hemochrome; 3)LDH-SGOT-Alkaline phosphatase; 4)Noradrenaline; 5)Cortisol. The following urine analyses were made: 1)Total catecholamines; 2)Vanillylmandelic acid. Clinical tests included: 1. Measurement of arterial pressure, at the beginning, at the end and during the driving period at the 30th and 90th minute. 2. Measurement of cardiac frequency,at the beginning, at the end and during the driving period at the same times. Blood pressure was measured by the auscultatory method, using an armband apparatus with aneroid capsule; cardiac frequency was measured at the wrist using the simple palpatory method, per 60 seconds.

Adult↗
PubMed1986

[Fitness for automobile driving of patients at an epilepsy outpatient care unit].

Patients who were free from seizures and not in possession of a driving license were examined for reasons for their being considered unfit to drive at an outpatient care centre for epileptics catering for 477 patients. The composition of the group was analyzed in respect of age, sex, intake of pharmaceuticals, risk factors and appropriateness of behaviour in traffic. Corresponding conclusions are drawn.

Ambulatory Care↗
PubMed2005

[Automobile driving and implantable defibrillators].

The consequences of implanting an automatic cardioverter defibrillator (ICD) on vehicle driving in France are poorly known. This retrospective study examined the behaviour at the wheel of ICD recipients who were recommended to abstain from driving for 3 to 6 months after device implantation. The study population included 98 patients (mean age = 59.5 +/- 14.8 years) followed for a mean of 24. +/- 23.9 months, who underwent ICD implant for ventricular tachycardia (65% of patients ventricular fibrillation (15%), syncope (8%), as part of a research protocol of myocardial cell transplantation 6%, or for primary prevention (5%). The underlying heart disease was ischemic in 59% of patients dilated cardiomyopathy in 11%,hypertrophic cardiomyopathy in 8%, valvular in 6%. Brugada syndrome in 4%, right ventricular arrhythmogenic cardiomyopathy in 2%, and miscellaneous disorders in 9% of patients. Five patients died without post mortem interrogation of the ICD. Only 28% of drivers remembered, and 13% observed, the recommended driving limitations. However, 45% (the oldest) claimed to drive prudently. During follow-up, 47% of patients received an ICD shock. Their mean it ventricular ejection fraction was 34 +/- 14%, versus 43 +/- 18% in patients who received no ICD therapy (p = 0.015). Syncope occurred in 16% who received ICD shocks. Shocks were delivered during driving in 6 patients, without consequent accident. Despite their non-observance of recommended driving limitations. ICD recipients suffered few traffic accidents. Legislation in France should reproduce the guidelines issued by European professional societies and enacted by the British laws.

Accidents, Traffic↗
PubMedDate not supplied

[Automobile driving by the aged].

BACKGROUND: Owing to the progressive ageing of our society and also to the great importance that we attach to driving, the number of elderly drivers (over sixty-five years old) is likely to increase significantly. It is also important to point out that during the last years it has been stated a bigger amount of traffic accidents among the members of this community. METHODS: In this article different aspects already published about aged drivers are revised. RESULTS: The reasons for this rise are both the greater number of old people with a driving licence and the deterioration in some capabilities which may appear at a certain age. CONCLUSIONS: The fact that Health Service professionals dealing with this specific group are of the first importance as far as their education in this area is emphasized.

Accidents, Traffic↗
PubMed2001

[Cannabis and automobile driving].

Cannabis use has increased considerably during the last 15 years. One of the major problems dealing with cannabis use is driving under the influence of drugs. With the exception of ethyl alcohol, the majority of the epidemiological studies have shown that cannabis is the most frequently detected substance in people suspected of driving under the influence of drugs. Experimental studies are therefore needed to assess cannabis effects on driving capability. Many studies indicate that cannabis impairs psychomotor performance. This impairment becomes obvious when high doses of cannabis are taken, when ethyl alcohol or other drugs are simultaneously ingested, or when sustained attention is needed. Moreover, cannabis effects are qualitatively different from those observed after ethyl alcohol consumption. In forensic practice, cannabis impairment of driving performance must be related to cannabinoids blood concentrations. To facilitate the interpretation of cannabinoids blood levels, several models were set up recently. These models must be further improved in order to fit in with all circumstances of cannabis use.

Accidents, Traffic↗
PubMed1993

[Automobile driving capacity of the elderly from the psychiatric viewpoint].

BASIC REMARKS: As the percentage of senior citizens in the general population increases, the number of elderly drivers is also increasing. This raises the general question as to the fitness of the elderly to participate in road traffic; the answer to this question must be considered within the larger context of ageing. Main points discussed: Acute psychiatric conditions (schizophrenic psychosis, melancholia, mania, organic psychosis, neurosis, addictive diseases) and decompensated neurosis and progressive dementia all render the victim unfit to drive. However, when the acute phase has been overcome, driving ability may well be re-established. Here, consideration must be given to psychopharmacological therapy. CONCLUSIONS: An elderly person's fitness to drive does not depend per se on chronological age or a given diagnosis. Rather, an individual assessment must take account of such parameters as psychopathology, personality, the ability to come to an agreement, the course of any psychiatric illness, and the effects of other somatic diseases and drugs.

Accidents, Traffic↗
PubMed1978

[Effect of tetrabamate, phenobarbital and a small quantity of alcohol on certain perceptive-motor aspects in connection with automobile driving].

Studies have been conducted of the respective effects a dose of 300 mg tetrabamate administered daily for one week, of 45 mg phenobarbital also given daily for one week (tetrabamate contains 15% phenobarbital) and of a small amount of alcohol alone or associated with one or the other of these drugs. Several perceptual-motor components involved in the driving function have been measured by testing signal detection of threshold contrast under mesopic vision following glare and without glare, critical fusion frequency, perceptual-motor reaction pattern for simple reaction time or choice reaction time during which the different signals do not appear with the same probability, and perceptual style by means of the rod-and-frame test.

Adult↗