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

From: Physicians’ role in the determination of fitness to drive in patients with Parkinson’s disease: systematic review of the assessment tools and a call for national guidelines

Types Methods Testing instruments Main findings Clinical recommendation
Questionnaires and structured interviews Questionnaires delivered during interviews Driving questionnaires [12, 5355, 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, 5961] • 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, 1921, 25, 37, 64, 7075, 7779, 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, 6467, 6971, 7380, 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, 6567, 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, 6973, 75, 7779, 82, 8588] • 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, 6769, 7275, 77, 78, 80, 8284, 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, 7375, 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, 6374] • 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, 7491] • 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.