Table 2 Driving assessment tools in Parkinson’s disease
Types | Testing methods | Advantages | Disadvantages |
|---|---|---|---|
Questionnaires and structure interviews | • Structured interview [53–55, 58] • The Epworth Sleepiness Scale [24, 40, 41, 56, 57, 59–61] • Restless legs syndrome questionnaire [61] • The sudden onset of sleep questionnaire [24] • SCOPA-sleep scale [62] | • Suitable for screening a large number of patients in a short period of time • Cost effective • Ability to capture subjective symptoms, e.g., sleepiness • No risk for physical injury during the test | • Lack specificity • Potential bias during recruitment. [12] • Findings may not be conclusive for final recommendations on driving. |
Off-road testing battery | • Motor assessment (HY, UPDRS-motor, Webster’s scale, rapid pace walk, disease duration, LEDs, etc.) [4, 21, 25, 37, 75, 77, 82, 88, 91] • Cognitive assessment (MMSE, Trail making test, Complex figure test, Dot cancellation, block design test, etc.) [13, 67, 69, 74–76, 80, 83, 84, 86, 88, 91] | • The tests provide clinical information of patients on their ability in motor, cognitive and visual domains. • Some jurisdictions use an off-road evaluation to predict on-road behavior [27] • No risk for physical injury. | • Findings may not be conclusive for final recommendations on driving. • Findings are limited to clinical information on individual patients, not his/her driving performance. |
Driving simulators | • Various types of driving simulators [4, 19, 20, 37, 63–74]. | • Ability to control and standardize testing conditions and methods • Various outcome parameters can be implemented. • Patients are not exposed to significant risk associated with on-road tests. | • No standardized protocols • Simulator sickness • Testing scenarios are not real. |
On-road tests | • An on-road test with/without instrument vehicle, and accompanied with a driver instructor for rating the driving score [3, 13, 14, 19, 21, 25, 74–91]. | • Considered as a gold standard driving test for licensing new drivers by most authorities [43, 86] • Provided realistic driving test • Standardized outcome parameters | • Potential physical injuries and accidents during the tests • Unfamiliar testing scenarios • Not suitable for patients with physical limitations or handicaps |
Naturalistic driving | • An attached devices equipped in a patients’ own car for collection of driving data [23, 92, 93]. | • The most realistic driving test with familiar environment | • Potential physical injuries and accidents during the tests • Potential risk imposed to others on the road • No standardized testing protocols |