Simulated car crashes and crash predictors in drivers with Alzheimerdisease
M. Rizzo
Bok Engelsk 1997
| Utgitt | 1997
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|---|---|
| Omfang | Side 545- 551
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| Opplysninger | Background: Alzheimer disease (AD) is the most common cause ofdementia and can impair cognitive abilities crucial to the task ofdriving. Rational decisions about whether such impaired individualsshould continue to drive require objective assessments of driverperformance.Objective: To measure relevant performance factors using high-fidelity driving simulation.Design: We examined the effect of AD on driver collision avoidanceusing the Iowa Driving Simulator, which provided a high-fidelity,closely controlled environment in which to observe serious errors byat-risk drivers. We determined how such unsafe events are predictedby visual and cognitive factors sensitive to decline in aging andAD.Setting: The University of Iowa Hospitals and Clinics, Iowa City, andthe Iowa Driving Simulator.Participants: Thirty-nine licensed drivers: 21 with AD and 18controls without dementia.Main Outcome Measures: We determined the number of crashes andrelated performance errors and analyzed how these occurrences werepredicted by visual and cognitive factors.Results: Six participants (29%) with AD experienced crashes vs 0 of18 control participants (P=.022). Drivers with AD were more thantwice as likely to experience close calls (P=.042). Plots of criticalcontrol factors in the moments preceding a crash revealed patterns ofdriver inattention and error. Strong predictors of crashes includedvisuospatial impairment, reduction in the useful field of view, andreduced perception of 3-dimensional structure-from-motion.Conclusions: High-fidelity driving simulation provides a unique newsource of performance parameters to standardize the assessment ofdriver fitness. Detailed observations of crashes and other safetyerrors provide unbiased evidence to aid in the difficult clinicaldecision of whether older or medically impaired individuals shouldcontinue to drive. The findings are complementary to evidencecurrently being gathered using techniques from epidemiology andcognitive neuroscience.
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