Glucose Control, Sleep, Obesity, and Real-World Driver Safety at Stop Intersections in Type 1 Diabetes

Background: Diabetes is associated with obesity, poor glucose control and sleep dysfunction which impair cognitive and psychomotor functions, and, in turn, increase driver risk. How this risk plays out in the real-world driving settings is terra incognita. Addressing this knowledge gap requires comprehensive observations of diabetes driver behavior and physiology in challenging settings where crashes are more likely to occur, such as stop-controlled traffic intersections, as in the current study of drivers with Type 1 Diabetes (T1DM). Methods: 32 active drivers from around Omaha, NE participated in 4-week, real-world study. Each participant's own vehicle was instrumented with an advanced telematics and camera system collecting driving sensor data and video. Videos were analyzed using computer vision models detecting traffic elements to identify stop signs. Stop sign detections and driver stopping trajectories were clustered to geolocate and extract driver-visited stop intersections. Driver videos were then annotated to record stopping behavior and key traffic characteristics. Stops were categorized as safe or unsafe based on traffic law. Results: Mixed effects logistic regression models examined how stopping behavior (safe vs. unsafe) in T1DM drivers was affected by 1) abnormal sleep, 2) obesity, and 3) poor glucose control. Model results indicate that one standard deviation increase in BMI (~7 points) in T1DM drivers associated with a 14.96 increase in unsafe stopping odds compared to similar controls. Abnormal sleep and glucose control were not associated with increased unsafe stopping. Conclusion: This study links chronic patterns of abnormal T1DM driver physiology, sleep, and health to driver safety risk at intersections, advancing models to identify real-world safety risk in diabetes drivers for clinical intervention and development of in-vehicle safety assistance technology.Comment: 23 pages, 7 figures, 10 table

Mental flexibility impairment in drivers with early Alzheimer’s disease: A simulator-based study

After memory impairment, one of the most common troubles of early Alzheimer’s disease (AD) is the impairment of executive functioning. However, it can have major consequences on daily life, notably on the driving activity. The present study focused on one important executive function involved in driving: mental flexibility; and considered how this impairment can affect driving. Ten patients with early AD were matched with 29 healthy older drivers. All participants were given an evaluation of mental flexibility through neuropsychological tests and an experimental test developed on a static driving simulator. The experiment was divided in two conditions; one without mental flexibility and another condition with a mental flexibility demand. AD patients showed impairments in the neuropsychological tests evaluating mental flexibility. These deficits are linked to the deficits they showed in the driving simulator flexibility tests. This study contributes to the understanding of mental flexibility mechanisms and on their role in driving activity. It also confirms that the driving simulator is a suitable tool to explore cognitive disorders and driving ability

Emotion Recognition and Traffic-Related Risk-Taking Behavior in Patients with Neurodegenerative Diseases

Objectives : Neurodegenerative diseases (NDDs), such as Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, and Huntington's disease, inevitably lead to impairments in higher-order cognitive functions, including the perception of emotional cues and decision-making behavior. Such impairments are likely to cause risky daily life behavior, for instance, in traffic. Impaired recognition of emotional expressions, such as fear, is considered a marker of impaired experience of emotions. Lower fear experience can, in turn, be related to risk-taking behavior. The aim of our study was to investigate whether impaired emotion recognition in patients with NDD is indeed related to unsafe decision-making in risky everyday life situations, which has not been investigated yet.  Methods: Fifty-one patients with an NDD were included. Emotion recognition was measured with the Facial Expressions of Emotions: Stimuli and Test (FEEST). Risk-taking behavior was measured with driving simulator scenarios and the Action Selection Test (AST). Data from matched healthy controls were used: FEEST (n = 182), AST (n = 36), and driving simulator (n = 18).   Results: Compared to healthy controls, patients showed significantly worse emotion recognition, particularly of anger, disgust, fear, and sadness. Furthermore, patients took significantly more risks in the driving simulator rides and the AST. Only poor recognition of fear was related to a higher amount of risky decisions in situations involving a direct danger.   Conclusions: To determine whether patients with an NDD are still fit to drive, it is crucial to assess their ability to make safe decisions. Measuring emotion recognition may be a valuable contribution to this judgment

The ‘frontal lobe’ project: A double-blind, randomized controlled study of the effectiveness of higher level driving skills training to improve frontal lobe (executive) function related driving performance in young drivers

The current study was undertaken in order to evaluate the effectiveness of higher level skills training on safe driving behaviour of 36 teenage drivers. The participants, who attended the Driver Training Research camp in Taupo (NZ) over a two week period, were 16 to 17 years old and had a valid restricted driver licence. The study focused on four main aims. Firstly, the behavioural characteristics of the sample and their attitudes to risk taking and driving were examined. Results showed that speeding was the most anticipated driving violation, and high levels of confidence were associated with a higher number of crashes and a greater propensity for risk taking. Many, often male participants, also rated their driving skills as superior to others and thought they would be less likely than others to be involved in an accident. Secondly, the relationship between driving performance and executive functioning, general ability and sustained attention was evaluated. Overall, better driving performance and more accurate self-evaluation of driving performance was related to higher levels of executive functions, in particular, working memory, and cognitive switching. In addition, higher general ability and greater ability to sustain attention were also linked to better performance on the driving related assessments. The third focus of this study was to compare the effects of both, higher level and vehicle handling skills training on driving performance, confidence levels and attitudes to risk. While both types of training improved direction control, speed choice and visual search, along with number of hazards detected and actions in relation to hazards, statistically significant improvement on visual search was seen only after higher level skills training. Vehicle handling skills training significantly improved direction control and speed choice. In addition, confidence levels in their driving skills were significantly lowered and attitudes to speeding, overtaking and close following had improved significantly in the participants after the higher level driving skills training. The final aspect to this study was to examine the effects of the training over the following 6 month period based on self-reported driving behaviour. The response rate of participants however, was not sufficient to reach any meaningful conclusion on any long-term training effects. A pilot study using GPSbased data trackers to assess post-training driving behaviour revealed some promising results for future driver training evaluation studies. The overall implications of the results are discussed in relation to improving the safety of young drivers in New Zealand

The good of boredom

I argue that the state of boredom (i.e., the transitory and non-pathological experience of boredom) should be understood to be a regulatory psychological state that has the capacity to promote our well-being by contributing to personal growth and to the construction (or reconstruction) of a meaningful lif

Diplopia in Parkinson's disease: Indication of a cortical phenotype with cognitive dysfunction?

Background: Visual disturbances are increasingly recognized as common non-motor symptoms in Parkinson's disease (PD). In PD patients, intermittent diplopia has been found to be associated with the presence of visual hallucinations and the Parkinson's psychosis spectrum. Here, we investigated whether diplopia in PD is associated with other non-motor traits and cognitive impairment. Methods: We investigated 50 non-demented PD patients with and without intermittent diplopia and 24 healthy controls for visual disturbances, as well as motor and non-motor symptoms. All participants underwent a neuropsychological test battery; visuospatial abilities were further evaluated with subtests of the Visual Object and Space Perception Battery (VOSP). The two PD patient groups did not differ significantly in age, symptom duration, motor symptom severity, frequency of visual hallucinations, or visual sensory efficiency. Results: PD patients with diplopia reported more frequent non-motor symptoms including more subjective cognitive problems and apathy without changes in global cognition measures compared to those without diplopia. PD patients with diplopia had greater impairment in several tests of visuospatial function (pentagon copying p = .002; number location p = .001; cube analysis p < .02) and object perception (p < .001) compared to PD patients without diplopia and healthy controls. By contrast, no consistent group differences were observed in executive function, memory, or language. Conclusions: PD patients with diplopia have a greater non-motor symptom burden and deficits in visuospatial function compared to PD patients without diplopia. PD patients with diplopia might be prone to a cortical phenotype with cognitive decline and apathy associated with worse prognosis

Driving performance in older adults: Current measures, findings, and implications for roadway safety

BACKGROUND AND OBJECTIVES: Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers. RESEARCH DESIGN AND METHODS: Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review. RESULTS: Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints. DISCUSSION AND IMPLICATIONS: There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy

EEG-Based Neurocognitive Metrics May Predict Simulated and On-Road Driving Performance in Older Drivers

The number of older drivers is steadily increasing, and advancing age is associated with a high rate of automobile crashes and fatalities. This can be attributed to a combination of factors including decline in sensory, motor, and cognitive functions due to natural aging or neurodegenerative diseases such as HIV-Associated Neurocognitive Disorder (HAND). Current clinical assessment methods only modestly predict impaired driving. Thus, there is a need for inexpensive and scalable tools to predict on-road driving performance. In this study EEG was acquired from 39 HIV+ patients and 63 healthy participants (HP) during: 3-Choice-Vigilance Task (3CVT), a 30-min driving simulator session, and a 12-mile on-road driving evaluation. Based on driving performance, a designation of Good/Poor (simulator) and Safe/Unsafe (on-road drive) was assigned to each participant. Event-related potentials (ERPs) obtained during 3CVT showed increased amplitude of the P200 component was associated with bad driving performance both during the on-road and simulated drive. This P200 effect was consistent across the HP and HIV+ groups, particularly over the left frontal-central region. Decreased amplitude of the late positive potential (LPP) during 3CVT, particularly over the left frontal regions, was associated with bad driving performance in the simulator. These EEG ERP metrics were shown to be associated with driving performance across participants independent of HIV status. During the on-road evaluation, Unsafe drivers exhibited higher EEG alpha power compared to Safe drivers. The results of this study are 2-fold. First, they demonstrate that high-quality EEG can be inexpensively and easily acquired during simulated and on-road driving assessments. Secondly, EEG metrics acquired during a sustained attention task (3CVT) are associated with driving performance, and these metrics could potentially be used to assess whether an individual has the cognitive skills necessary for safe driving