Driving and off-road impairments underlying failure on road testing in Parkinson's disease

Authors

  • Hannes Devos PhD,

    Corresponding author
    1. Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven–University of Leuven, Leuven, Belgium
    2. National Advanced Driving Simulator, University of Iowa, Iowa City, Iowa, USA
    3. Department of Physical Therapy, Georgia Regents University, Augusta, Georgia, USA
    • Correspondence to: Dr. Hannes Devos, Georgia Regents University; College of Allied Health Sciences; Department of Physical Therapy; 1120 15th Street, EC-1304; Augusta, GA 30912; hdevos@gru.edu

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  • Wim Vandenberghe MD, PhD,

    1. Department of Neurology, University Hospitals Leuven, Leuven, Belgium
    2. Department of Neurosciences, Katholieke Universiteit (KU) Leuven–University of Leuven, Leuven, Belgium
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  • Mark Tant PhD,

    1. Center for Evaluation of Fitness to Drive (CARA), Belgian Road Safety Institute, Brussels, Belgium
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  • Abiodun E. Akinwuntan PhD, MPH,

    1. Department of Physical Therapy, Georgia Regents University, Augusta, Georgia, USA
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  • Willy De Weerdt PhD,

    1. Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven–University of Leuven, Leuven, Belgium
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  • Alice Nieuwboer PhD,

    1. Department of Rehabilitation Sciences, Katholieke Universiteit (KU) Leuven–University of Leuven, Leuven, Belgium
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  • Ergun Y. Uc MD

    1. Department of Neurology, University of Iowa, Iowa City, Iowa, USA
    2. Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa, USA
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  • Funding agencies: This work was supported by the Department of Rehabilitation Sciences of KU Leuven and CARA, Belgian Road Safety Institute.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Parkinson's disease (PD) affects driving ability. We aimed to determine the most critical impairments in specific road skills and in clinical characteristics leading to failure on a road test in PD. In this cross-sectional study, certified driving assessment experts evaluated specific driving skills in 104 active, licensed drivers with PD using a standardized, on-road checklist and issued a global decision of pass/fail. Participants also completed an off-road evaluation assessing demographic features, disease characteristics, motor function, vision, and cognition. The most important driving skills and off-road predictors of the pass/fail outcome were identified using multivariate stepwise regression analyses. Eighty-six (65%) passed and 36 (35%) failed the on-road driving evaluation. Persons who failed performed worse on all on-road items. When adjusted for age and gender, poor performances on lateral positioning at low speed, speed adaptations at high speed, and left turning maneuvers yielded the best model that determined the pass/fail decision (R2 = 0.56). The fail group performed poorer on all motor, visual, and cognitive tests. Measures of visual scanning, motor severity, PD subtype, visual acuity, executive functions, and divided attention were independent predictors of pass/fail decisions in the multivariate model (R2 = 0.60). Our study demonstrated that failure on a road test in PD is determined by impairments in specific driving skills and associated with deficits in motor, visual, executive, and visuospatial functions. These findings point to specific driving and off-road impairments that can be targeted in multimodal rehabilitation programs for drivers with PD. © 2013 International Parkinson and Movement Disorder Society

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