ABSTRACT

Driving is an important activity of daily living and is essential for mobility and independence for many individuals. Parkinson’s disease (PD) impairs motor function, cognition, vision, sleep, and alertness1 and is associated with lower performance on road tests2-13 and driving simulator experiments14-23 compared with controls, as well as with

loss of mobility (driving cessation) on cross-sectional or retrospective24-33 and prospective34 surveys. Driving simulation studies have shown increased crash rates in PD15,20,22 and retrospective surveys with a variety of limitations have suggested increased crashes25 or higher proportion of being at-fault in crashes in drivers with PD.29 However, increased real-life crash risk in drivers with PD has not been conrmed by community-based, prospective, controlled studies or epidemiological research so far.31,34,35

Scope of the Driving Problem in Parkinson’s Disease ........................................................................................................... 1221 Consequences of Crashes and Driving Cessation .............................................................................................................. 1222 Aging Population and Potential Increase of Cognitively Impaired Drivers with PD......................................................... 1222 Challenge for Healthcare Providers ................................................................................................................................... 1222

Theoretical Framework to Study Driving ............................................................................................................................... 1222 Models of Driving Behavior .............................................................................................................................................. 1222 Neural Substrates of Driving .............................................................................................................................................. 1223

Multitasking .................................................................................................................................................................. 1224 Application to PD ............................................................................................................................................................... 1224

Driving Research in PD .......................................................................................................................................................... 1225 Research Approach............................................................................................................................................................. 1225

Study Design ................................................................................................................................................................. 1225 Outcome Measures ........................................................................................................................................................ 1225

Off-Road Battery ................................................................................................................................................................ 1226 Demographics ................................................................................................................................................................ 1226 Driving History and Habits ........................................................................................................................................... 1226 Assessments of Cognition, Vision, Motor Function, Indices of Parkinsonism, Sleep, Psychiatric Problems .............. 1226

Road Testing ....................................................................................................................................................................... 1227 Introduction to Road Testing Methods .......................................................................................................................... 1227 Overall Safety ................................................................................................................................................................ 1228 Multitasking ...................................................................................................................................................................1231