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Predictors of fitness to drive in people with Parkinson disease

From the Department of Rehabilitation Sciences (H.D., A.N., W.D.W.) and Department of Neurology, University Hospital Gasthuisberg (W.V.), Katholieke Universiteit Leuven; and CARA unit (M.T., G.B.), Belgian Road Safety Institute, Brussels, Belgium.

Address correspondence and reprint requests to Drs. Hannes Devos, Katholieke Universiteit Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Tervuursevest 101, BE-3001 Leuven, Belgium

Objective: To develop an efficient clinical screening battery to accurately predict the fitness to drive in people with Parkinson disease (PD).

Methods: This prospective study included 80 participants: 40 patients with PD and 40 healthy age- and sex-matched control subjects. All participants were assessed using a driving simulator, a driving history survey, and the Clinical Dementia Rating. The patients with PD also underwent a clinical test battery and an evaluation of fitness to drive performed by an official center, which included visual, cognitive, and on-road tests. A two-class decision from this driving assessment center was the main outcome measure.

Results: A screening battery assessing four clinical variables (disease duration, contrast sensitivity, Clinical Dementia Rating, and motor part of the Unified Parkinson’s Disease Rating Scale) provided the best model (R² = 0.52) to predict the fitness to drive and correctly classified 36 (90%) of the patients with PD as pass or fail (sensitivity = 91%, specificity = 90%). The Test Ride for Investigating Practical fitness to drive (TRIP) driving simulator score discriminated significantly between drivers with PD and their healthy peers (p = 0.0008). When the TRIP driving simulator score was added to the clinical model, the total explained variance increased (R² = 0.60) and correctly classified 39 (97.5%) of drivers with PD into the pass/fail category (sensitivity = 91%, specificity = 100%).

Conclusions: A short clinical screening battery that measures disease duration, contrast sensitivity, cognitive and motor functions can predict fitness to drive in people with Parkinson disease with a high degree of accuracy.

GLOSSARY: ADL = activities of daily living; CDR = Clinical Dementia Rating; CS = contrast sensitivity; DBS = deep brain stimulator; ESS = Epworth Sleepiness Scale; IQR = interquartile range (Q1–Q3); NA = not applicable; PD = Parkinson disease; r_b = biserial correlation coefficient; r_rb = rank biserial correlation coefficient; r_s = Spearman rank correlation coefficient; TRIP = Test Ride for Investigating Practical fitness to drive; UFOV = useful field of view; UPDRS II = Unified Parkinson’s Disease Rating Scale, activities of daily living; UPDRS III = Unified Parkinson’s Disease Rating Scale, motor scale; w = Wilcoxon rank sum test.

Hannes.Devos{at}faber.kuleuven.be

Funded by a grant from the Nationale Vereniging voor Steun aan Gehandicapten and DVV insurances of Belgium. W.V. is a Senior Clinical Investigator of the Fund for Scientific Research–Flanders.

Disclosure: The authors report no conflicts of interest.

Received February 14, 2007. Accepted in final form April 27, 2007.