Table 3 Summary of studies involving driving assessment tools in patients with Parkinson’s disease

Questionnaires and structured interviews

Questionnaires delivered during interviews

Driving questionnaires [12, 53–55, 58, 62]

• PD drivers reported a high incident of collisions [12, 53, 62]. Patients with higher disease severity reported more collisions.

• Up to 21 % of PD drivers gave up driving soon after diagnosis was made [12, 53]

• Falling asleep while driving was a significant pre had found in PD drivers, and usually related with dopamine agonist medications [54, 55, 58]

• Appropriate as a screening instrument for physicians in routine clinical practice

Epworth sleepiness scale [24, 40, 41, 56, 57, 59–61]

• Excessive daytime somnolence (EDS) and sleep attacks are more common in PD drivers than controls [40, 60, 61].

• EDS is associated with dopamine agonist medications [56]

• PD drivers scored worse on ESS score than controls [60, 61]

• Falling asleep while driving a car was a significant prognostic factor of car accidents [24, 59]

• ESS is a useful screening instrument for EDS and sleep attacks in PD patients. This test should be performed in PD drivers with history of daytime somnolence.

2. Off-road testing battery

Motor assessment

Hoehn & Yahr [3, 4, 13, 14, 19–21, 25, 37, 64, 70–75, 77–79, 81, 91]

• Greater HY score correlated with higher number of collisions or driving errors [37]

• Greater HY score correlated with poor driving performance and a failed result with on-road tests [21, 25, 75, 77]

• HY scale should be part of the clinical evaluation in PD patients who come for fitness to drive assessment.

UPRDS-motor [13, 14, 19, 20, 23, 25, 37, 64–67, 69–71, 73–80, 82, 91]

• High UPDRS-motor score correlated with greater of collision [37]

• High UPDRS-motor score is a significant predictor of poor driving performance and fitness to drive [25, 75, 82]

• UPDRS-motor scale should be part of the clinical evaluation in PD patients who come for fitness to drive assessment.

Rapid pace walk test (RPW) [75, 88]

• Poor rapid pace walk test correlated with poor driving performance [75, 88]

• RPW test may be considered as an off-road test in PD patients who come for fitness to drive evaluation.

• More studies are needed to confirm its clinical validity.

Webster’s scale [4, 63, 76]

• Poor Webster’s scale correlated with poor driving performance [4]

• Webster’s scale should be part of the clinical evaluation in PD patients who come for fitness to drive assessment.

Disease duration and/or LEDs [13, 14, 19, 20, 23, 65–67, 69, 73, 79, 81, 82, 86, 87, 89, 91]

• Disease duration and/or LEDs did not correlate with driving performance.

• Disease duration and medication review should form part of basic clinical evaluation in PD patients at every visit.

Cognitive assessment

MMSE [3, 13, 14, 20, 21, 25, 37, 65, 66, 69–73, 75, 77–79, 82, 85–88]

• Poor MMSE score correlated with higher number of collisions [37]

• Poor MMSE scores correlated with poor driving performance. [86, 88]

• MMSE should be part of the clinical evaluation in PD patients who come for fitness to drive assessment.

Trial A&B making test [13, 20, 21, 67–69, 72–75, 77, 78, 80, 82–84, 86, 87]

• Poor performance on Trail A&B making test correlated with poor driving performance and more driving errors [13, 67, 69, 75, 80, 83, 86]

• Neurocognitive tests should be considered in PD patients with cognitive complaints who come for fitness to drive assessment.

Complex figure test [13, 20, 25, 83, 84]

• Poor performance on complex figure test correlated with poor driving performance. [13, 83, 84]

• Neurocognitive tests should be considered in PD patients with cognitive complaints who come for fitness to drive assessment.

Block design test [68, 83, 86] [84],

• Poor performance on block design tests correlated with poor driving performance [84, 86]

• Neurocognitive tests should be considered in PD patients with cognitive complaints who come for fitness to drive assessment.

Dot cancellation test [74, 76, 78]

• Poor performance on Dot cancellation test correlated with decreased driving ability [74, 76]

• Neurocognitive tests should be considered in PD patients with cognitive complaints who come for fitness to drive assessment.

Visual assessment

UFOV [13, 19, 25, 68, 73–75, 78, 79, 82, 84, 87, 89, 91]

• Decreased UFOV score correlated with poor driving performance and higher collision risk [13, 25, 75, 80, 82, 84]

• Visual assessment with UFOV may be considered in PD patients who come for fitness to drive assessment.

Pelli-Robson contrast sensitivity [23, 78, 79, 89, 91]

• Low-contrast visibility conditions imposed significant hazard for PD drivers.

• More studies are needed to confirm the validity of this test.

Visual acuity [19, 20, 74, 75, 78, 91]

• Poor visual acuity limits driving ability in PD patients.

• Visual acuity should be performed in PD patients who come for fitness to drive assessment.

Driving simulators

Driving simulators (16 papers)

Driving simulators [4, 19, 20, 37, 63–74]

• PD drivers committed more driving errors than controls [4, 37, 63],

• Greater PD disease severity determined with UPDRS or HY scale are correlated with poor driving performance [4]

• Poor performance on cognitive test especially with executive testing and visual attention correlated with more driving errors [20, 37]

• Driver assistance improved the driving performance in PD patients [69, 72]

• Physicians should consult local authorities on PD patients who may be unfit to drive for further evaluation.

4. Driving skill test

On-road tests (24 papers)

On-road tests [3, 13, 14, 19, 21, 25, 74–91]

• PD drivers performed worse on on-road tests when compared to controls [3]

• Greater PD disease severity determined with UPDRS or H&Y scale correlated with poor driving performance [3, 82, 89]

• Poor performance on cognitive and/or visual tests affect driving ability in PD patients [25, 82]

• Physicians should consult local authorities on PD patients who may be unfit to drive for further evaluation.

Naturalistic driving (3 papers)

Naturalistic driving [23, 92, 93]

• PD drivers committed more errors, as shown by slow brake response time and slow reaction time [23]

• Physicians should consult local authorities on PD patients who may be unfit to drive for further evaluation.