Συμπεριφορά κυκλοφορίας και ασφάλειας οδηγών με νευρολογικές παθήσεις που επηρεάζουν τις νοητικές λειτουργίες

The objective of the present inter-disciplinary PhD dissertation is the analysis of traffic and safetybehaviour of drivers with neurological diseases affecting cognitive functions. More specifically, theimpact of brain pathologies on reaction time, accident probability, driving errors, and drivingperformance is under investigation. The driving behaviour is examined in terms of both traffic and safety behaviour and the neurological diseases affecting cognitive functions concern Alzheimer’sdisease (AD), Parkinson’s disease (PD), and Mild Cognitive Impairment (MCI). A large-scale drivingsimulator experiment was carried out, comprising a medical/neurological and neuropsychologicalassessment of 225 drivers, and a set of driving tasks for different scenarios. An innovative statisticalanalysis methodology has been developed and implemented, based on Regression Models, PrincipalComponent Analysis and Structural Equation Models. Results indicated that the impact of neurologicaldiseases affecting cognitive functions is significantly detrimental on traffic and safety behaviour. TheAD group had the worse driving performance profile among the examined brain pathologies and finally, the negative impact of the mobile phone use on driving performance was much more pronounced on drivers with neurological diseases affecting cognitive functions than on healthy controls of similar demographics.Ο στόχος της παρούσας διεπιστημονικής Διδακτορικής Διατριβής είναι η ανάλυση της συμπεριφοράς κυκλοφορίας και ασφάλειας οδηγών με νευρολογικές παθήσεις που επηρεάζουν τις νοητικές λειτουργίες. Ειδικότερα, είναι υπό διερεύνηση η επιρροή των εγκεφαλικών παθολογιών στον χρόνο αντίδρασης, στην πιθανότητα ατυχήματος, στα οδηγικά λάθη και στην οδηγική επίδοση. Η οδηγική συμπεριφορά εξετάστηκε σε όρους κυκλοφορίας αλλά και οδικής ασφάλειας και οι νευρολογικές ασθένειες που επηρεάζουν τις νοητικές λειτουργίες που εξετάζονται είναι η Νόσος Alzheimer (AD), η Νόσος Parkinson (PD) και η Ήπια Νοητική Εξασθένηση (MCI). Πραγματοποιήθηκε ένα μεγάλης κλίμακας πείραμα σε προσομοιωτή οδήγησης, το οποίο περιελάμβανε ιατρική/νευρολογική και νευροψυχολογική αξιολόγηση 225 οδηγών, καθώς και οδήγηση σε διαφορετικές συνθήκες.Αναπτύχθηκε και εφαρμόστηκε μια πρωτότυπη μεθοδολογία στατιστικής ανάλυσης βασισμένη σε Μοντέλα Παλινδρόμησης, Ανάλυση Κύριων Παραγόντων και Δομικά Μοντέλα Εξισώσεων. Τα αποτελέσματα έδειξαν ότι η επιρροή των νευρολογικών παθήσεων που επηρεάζουν τις νοητικές λειτουργίες είναι σημαντικά επιζήμια στην κυκλοφοριακή και οδηγική συμπεριφορά. Η ομάδα των ασθενών με AD είχαν το χειρότερο προφίλ οδηγικής επίδοσης ανάμεσα στις εξεταζόμενες ασθένειες και τέλος, η αρνητική επίδραση της χρήσης του κινητού τηλεφώνου στην οδηγική επίδοση ήταν πολύ εντονότερη στους ασθενείς με εγκεφαλική νευρολογική παθολογία σε σχέση με τους υγιείς με παρόμοια δημογραφικά χαρακτηριστικά

An overview of car occupant fatalities in the European countries

Car occupants have a high level of mortality in road accidents, since passenger cars are the prevalent mode of transport. In 2013, car occupant fatalities accounted for 45% of all road accident fatalities in the EU. The objective of this research is the analysis of basic road safety parameters related to car occupants in the European countries over a period of 10 years (2004-2013), through the exploitation of the EU CARE database with disaggregate data on road accidents. Data from the EU Injury Database for the period 2005 - 2008 are used to identify injury patterns, and additional insight into accident causation for car occupants is offered through the use of in-depth accident data from the EC SafetyNet project Accident Causation System (SNACS). The results of the analysis allow for a better understanding of the car occupants’ safety situation in Europe, thus providing useful support to decision makers working for the improvement of road safety level in Europe

How telemedicine can improve the quality of care for patients with alzheimer’s disease and related dementias? A narrative review

Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer’s disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population

Συμπεριφορά κυκλοφορίας και ασφάλειας οδηγών με νευρολογικές παθήσεις που επηρεάζουν τις νοητικές λειτουργίες

The objective of the present inter-disciplinary PhD dissertation is the analysis of traffic and safetybehaviour of drivers with neurological diseases affecting cognitive functions. More specifically, theimpact of brain pathologies on reaction time, accident probability, driving errors, and drivingperformance is under investigation. The driving behaviour is examined in terms of both traffic and safety behaviour and the neurological diseases affecting cognitive functions concern Alzheimer’sdisease (AD), Parkinson’s disease (PD), and Mild Cognitive Impairment (MCI). A large-scale drivingsimulator experiment was carried out, comprising a medical/neurological and neuropsychologicalassessment of 225 drivers, and a set of driving tasks for different scenarios. An innovative statisticalanalysis methodology has been developed and implemented, based on Regression Models, PrincipalComponent Analysis and Structural Equation Models. Results indicated that the impact of neurologicaldiseases affecting cognitive functions is significantly detrimental on traffic and safety behaviour. TheAD group had the worse driving performance profile among the examined brain pathologies and finally, the negative impact of the mobile phone use on driving performance was much more pronounced on drivers with neurological diseases affecting cognitive functions than on healthy controls of similar demographics.Ο στόχος της παρούσας διεπιστημονικής Διδακτορικής Διατριβής είναι η ανάλυση της συμπεριφοράς κυκλοφορίας και ασφάλειας οδηγών με νευρολογικές παθήσεις που επηρεάζουν τις νοητικές λειτουργίες. Ειδικότερα, είναι υπό διερεύνηση η επιρροή των εγκεφαλικών παθολογιών στον χρόνο αντίδρασης, στην πιθανότητα ατυχήματος, στα οδηγικά λάθη και στην οδηγική επίδοση. Η οδηγική συμπεριφορά εξετάστηκε σε όρους κυκλοφορίας αλλά και οδικής ασφάλειας και οι νευρολογικές ασθένειες που επηρεάζουν τις νοητικές λειτουργίες που εξετάζονται είναι η Νόσος Alzheimer (AD), η Νόσος Parkinson (PD) και η Ήπια Νοητική Εξασθένηση (MCI). Πραγματοποιήθηκε ένα μεγάλης κλίμακας πείραμα σε προσομοιωτή οδήγησης, το οποίο περιελάμβανε ιατρική/νευρολογική και νευροψυχολογική αξιολόγηση 225 οδηγών, καθώς και οδήγηση σε διαφορετικές συνθήκες.Αναπτύχθηκε και εφαρμόστηκε μια πρωτότυπη μεθοδολογία στατιστικής ανάλυσης βασισμένη σε Μοντέλα Παλινδρόμησης, Ανάλυση Κύριων Παραγόντων και Δομικά Μοντέλα Εξισώσεων. Τα αποτελέσματα έδειξαν ότι η επιρροή των νευρολογικών παθήσεων που επηρεάζουν τις νοητικές λειτουργίες είναι σημαντικά επιζήμια στην κυκλοφοριακή και οδηγική συμπεριφορά. Η ομάδα των ασθενών με AD είχαν το χειρότερο προφίλ οδηγικής επίδοσης ανάμεσα στις εξεταζόμενες ασθένειες και τέλος, η αρνητική επίδραση της χρήσης του κινητού τηλεφώνου στην οδηγική επίδοση ήταν πολύ εντονότερη στους ασθενείς με εγκεφαλική νευρολογική παθολογία σε σχέση με τους υγιείς με παρόμοια δημογραφικά χαρακτηριστικά

Impact of mobile phone use on driving performance: findings from a simulator study

Mobile phone use while driving is one of the most common driver distractions and one of the main causes of"br" traffic accidents. This research aims to investigate the impact of mobile phone use on drivers’ behaviour in urban"br" and rural road networks. A driving simulator experiment with 50 participants was carried out, who drove under"br" different types of mobile phone distraction (no distraction, handheld conversation, handsfree conversation,"br" speaker mode conversation). Within the framework of the statistical analysis, discrete choice models were"br" designed to investigate the influence of mobile phone use, as well as other relevant parameters, on driving"br" behaviour considering maximum driving speed, reaction time and standard deviation of lateral position. Based"br" on the findings of the present research, mobile phone conversation is significantly affecting driving performance"br" causing lower drivers’ maximum speeds and higher reaction times and standard deviations of the lateral position

Driving Performance Profiles of Drivers with Brain Pathologies in Rural Roads

The driving ability can be affected by various motor, visual, cognitive and perceptual deficits which are either age-related or caused by neurologic disorders. More specifically, diseases affecting a person's brain functioning may significantly impair the person's driving ability. The objective of this paper is to examine the driving performance profiles of drivers with some brain pathology in rural driving environment, in low and high traffic conditions, by means of a driving simulator experiment. Various driving performance measures are examined, e.g. mean driving speed, lateral position, steering angle, headway and reaction time at unexpected events. The driving performance of patients with brain pathologies is compared to that of healthy controls. 114 participants of above 55 years of age have completed the experimental procedure. Results suggest that there are differences between the two examined groups. Patients drive at lower speeds, present higher lateral position variability, keep larger headways and demonstrate worse reaction times than the control group

Driving Behaviour in Depression Based on Subjective Evaluation and Data from a Driving Simulator

Road traffic collisions are a major issue for public health. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Patients with depression (N = 39) and healthy controls (N = 30) were asked to complete questionnaires and to drive on a driving simulator in different scenarios. Driving simulator data included speed, safety distance from the preceding vehicle and lateral position. Demographic and medical information, insomnia (Athens Insomnia Scale, AIS), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Fatigue Severity Scale, FSS), symptoms of sleep apnoea (StopBang Questionnaire) and driving (Driver Stress Inventory, DSI and Driver Behaviour Questionnaire, DBQ) were assessed. Gender and age influenced almost all variables. The group of patients with depression did not differ from controls regarding driving behaviour as assessed through questionnaires; on the driving simulator, patients kept a longer safety distance. Subjective fatigue was positively associated with aggression, dislike of driving, hazard monitoring and violations as assessed by questionnaires. ESS and AIS scores were positively associated with keeping a longer safety distance and with Lateral Position Standard Deviation (LPSD), denoting lower ability to keep a stable position. It seems that, although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, patients drive more carefully eliminating, thus, their impact

Perceptions of Patients, Caregivers, and Healthcare Professionals toward Telemedicine Use for Cognitive and Movement Disorders in the Aegean Islands, Greece: A Pilot Study of the SI4CARE European Project

Background: Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands. Methods: Data were derived from the “Specialized Outpatient Clinic of Memory, Dementia and Parkinson’s disease through the National Telemedicine Network”, March 2021–March 2023. The survey included 10 questions (5-point Likert scale). Results: We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information. Conclusions: The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas

Predictors of accidents in people with mild cognitive impairment, mild dementia due to Alzheimer's disease and healthy controls in simulated driving

Objectives: To examine the driving variables that predict accident probability in mild dementia due to Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy older control drivers in simulated driving. To compare the three groups in mean performance and in frequency of scores exceeding 1.5 SD from the mean. Methods/Design: Participants were 37 drivers with MCI, 16 drivers with AD, and 21 control drivers over the age of 52. Driving measures were derived from four rural driving conditions: moderate traffic without and with distraction and high traffic without and with distraction. The measures were z-transformed based on the performance of 90 control drivers of different ages. Two unexpected incidents occurred per condition, requiring the sudden breaking to avoid an accident. Results: Drivers with AD showed significantly lower average speed, speed variability, greater headway distance, headway variability and average reaction time (RT) than control drivers. Drivers with MCI showed significantly lower average speed, greater headway distance and average RT than control drivers in the two conditions of distraction. No differences were found in accident probability. Drivers with AD had more deviant scores than both control drivers and drivers with MCI in most comparisons. Predictors of accident probability were average RT, speed variability and lateral position variability but MCI and AD status were not significant predictors in any of the regression models. Conclusions: Despite significant differences in performance, drivers with MCI and AD did not differ in accident probability from control drivers. An individualized approach of examining individual driving performance is recommended.Safety and Security Scienc