Longitudinal Two-Year Follow-Up of Updating and Flexibility Functions in Drivers with Parkinson’s Disease: Preliminary Results

This paper outlines the preliminary results of a longitudinal follow up at two years interval (t0 versus t2) in 10 drivers with mild to moderate Parkinson’s disease (PD) and 10 matched controls. Changes of (1) driving habits assessed by a questionnaire, (2) neuropsychological performances measured by a set of cognitive tests and (3) cognitive abilities while driving using a simulator, were analyzed. Two types of changes were observed: the decline over time in PD group at two years interval and the appearance of some deficits in PD patients (compared to controls) at the second assessment (t2). These deficits were not observed at the first one (t0). The results showed that PD patients had changed their driving habits over time (reduction of mileage, more avoidance, underestimation of their own driving competency). The cognitive status of PD patients remained relatively stable over time, except for the Trail Making Test performances (part A and part B) which declined. A deficit for the TMT-part A in PD patients, compared to controls, appeared at t2. The data from driving simulator showed no significant decline in PD patients for both updating and flexibility performances. However, a deficit in flexibility appeared at t2 in PD patients, as demonstrated by their poorer performances on the flexibility cost. Our data suggest that flexibility may be significantly affected in PD patients with more advanced disease. The small size on our sample does not allow us any conclusion on updating function in both PD patients and controls

Exploring the cognitive workload during a visual search task in Parkinson's Disease

International Congress of Parkinson's Disease and Movement Disorders , NICE, FRANCE, 22-/09/2019 - 26/09/2019Objective: To investigate cognitive workload during a visual search task in patients with Parkinson's disease (PD). Background: Visual search is one of the most important features of human activity. Visual search may be impaired in PD, which in turn may negatively affect daily life activities, such as driving. While previous studies explored visual exploration strategies during visual search tasks, no study investigated cognitive workload during visual search in PD. Cognitive workload refers to the total amount of mental effort being used to perform a task. Methods: Twenty patients with PD (age: 69 ± 8 yo; sex (Men/Women): 16/4) and 15 controls (age: 61 ± 11 yo; sex: 8/7) performed a visual search task on a driving simulator, that provides a context similar to visual search during real-life driving. They were instructed to search for a target road sign among distractor road signs. In half of the trials, the target was present (target-present trials). Response times as well as measures of cognitive workload for correct detections trials were investigated in the two groups. Cognitive workload was measured by the Index of Cognitive Activity (ICA), which was based on the number of times per second that an abrupt discontinuity in the pupil signal was detected. To investigate the cognitive workload over time for correct detection trials in the two groups, response time values were transformed to a continuous scale of percentage completion time, ranging from 0 (start of the trial) to 100% (button press) since response times were different between participants. Results: PD patients were significantly slower than controls to respond correctly to the visual search task, particularly for target-present trials. PD patients had increased values in cognitive workload throughout the entire duration of the task when compared to baseline (p < 0.05). By contrast, few significant differences were observed in controls (at 5% and 15%). Conclusions: These findings suggest that PD patients required increased and longer effort to correctly perform the visual search task compared with baseline cognitive workload. The use of ICA in patients with PD while performing a static visual search task provides new information into the effort (cognitive workload) required by patients on a moment-to-moment basis

Agreement Between Physician Rating and On-Road Decision for Drivers with Multiple Sclerosis

The recommendation of the referring physician is paramount in the decision making process of fitness to drive for individuals with multiple sclerosis (MS). This medical advice is carefully considered by fitness to drive officials when making a final decision. In this study, we sought to determine the reliability between physician recommendation and decision of the on-road assessor in 95 individuals with MS. The percentage agreement (po) and prevalence and bias adjusted kappa (PABAK) were used as measures of reliability. The on-road assessor found no concerns on the road in 87 (92%) of the individuals; 6 (6%) exhibited difficulties on the road that were of concern; and 2 (2%) were advised to discontinue driving based on the findings of the road test. The po between referring physician and on-road assessor was 83%. The PABAK showed a reliability coefficient of 0.76 (p \u3c 0.0001). No differences were found in po between neurologists (83%) and general practitioners (88%, Fisher’s Exact = 0.56). Binocular acuity correlated significantly with the on-road driving decision (Spearman = -0.30; p = 0.004). We conclude that, in this sample of drivers with MS, physicians were most of the time accurate in their appraisal of their patients’ driving capabilities

Comorbidities in Drivers with Parkinson Disease

Previous studies have shown that comorbidities have an impact on driving performance in older adults. No study has established the relationships between comorbidities and driving in persons with Parkinson disease (PD). The aims of this study were (1) to report the types of comorbidity in a group of 111 drivers with PD and (2) to identify whether the comorbidity associated with PD is a predictor of overall fitness-to-drive decisions, crashes, and validity duration of driving license. Results showed that 72 participants (64.9%) had only Parkinson disease, and 39 (35.1%) participants had one or more medical conditions in addition to PD. The most frequent comorbidities were visual disorders (26.4%), heart and blood disorders (16.2%), neurological disorders other than PD (11.8%), and locomotor disorders (11.8%). Contrarily to what we expected, we did not find any significant associations between comorbidities and overall fitness-to-drive decisions, car crashes, or validity duration of driving license. We conclude that in this sample of drivers with PD, comorbidity was not a significant predictor of overall fitness-to-drive decisions

Effect of Cognitive Demand on Functional Visual Field Performance in Senior Drivers with Glaucoma

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Purpose: To investigate the effect of cognitive demand on functional visual field performance in drivers with glaucoma. Method: This study included 20 drivers with open-angle glaucoma and 13 age- and sex-matched controls. Visual field performance was evaluated under different degrees of cognitive demand: a static visual field condition (C1), dynamic visual field condition (C2), and dynamic visual field condition with active driving (C3) using an interactive, desktop driving simulator. The number of correct responses (accuracy) and response times on the visual field task were compared between groups and between conditions using Kruskal–Wallis tests. General linear models were employed to compare cognitive workload, recorded in real-time through pupillometry, between groups and conditions. Results: Adding cognitive demand (C2 and C3) to the static visual field test (C1) adversely affected accuracy and response times, in both groups (p < 0.05). However, drivers with glaucoma performed worse than did control drivers when the static condition changed to a dynamic condition [C2 vs. C1 accuracy; glaucoma: median difference (Q1–Q3) 3 (2–6.50) vs. controls: 2 (0.50–2.50); p = 0.05] and to a dynamic condition with active driving [C3 vs. C1 accuracy; glaucoma: 2 (2–6) vs. controls: 1 (0.50–2); p = 0.02]. Overall, drivers with glaucoma exhibited greater cognitive workload than controls (p = 0.02). Conclusion: Cognitive demand disproportionately affects functional visual field performance in drivers with glaucoma. Our results may inform the development of a performance-based visual field test for drivers with glaucoma

An innovative therapeutic educational program to support older drivers with cognitive disorders: Description of a randomized controlled trial study protocol

Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the “Current Self-Regulatory Practices” subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary.Clinical trial registration numberNCT04493957

Eye tracking – The overlooked method to measure cognition in neurodegeneration?

Eye tracking (ET) studies are becoming increasingly popular due to rapid methodological and technological advances as well as the development of cost efficient and portable eye trackers. Although historically ET has been mostly employed in psychophysics or developmental cognition studies, there is also promising scope to use ET for movement disorders and measuring cognitive processes in neurodegeneration. Particularly, ET can be a powerful tool for cognitive and neuropsychological assessments of patients with pathologies affecting motor and verbal abilities, as tasks can be adapted without requiring motor (except eye movements) or verbal responses. In this review, we will examine the existing evidence of ET methods in neurodegenerative conditions and its potential clinical impact for cognitive assessment. We highlight that current evidence for ET is mostly focused on diagnostics of cognitive impairments in neurodegenerative disorders, where it is debatable whether it has any more sensitivity or specificity than existing cognitive assessments. By contrast, there is currently a lack of ET studies in more advanced disease stages, when patients’ motor and verbal functions can be significantly affected, and standard cognitive assessments are challenging or often not possible. We conclude that ET is a promising method not only for cognitive diagnostics but more importantly, for potential cognitive disease tracking in progressive neurodegenerative conditions

Advances and Insights into Neurological Practice 2016-17

Papers published by the European Journal of Neurology reflect the broad interest of practicing neurologists in advances in the aetiology, diagnosis and management of neurological disorders. As a general journal, the proportion of papers in the different subject areas reasonably reflects the case load of a practising neurologist. Stroke represents the largest proportion of papers published, including those on pathophysiology (1-23), acute stroke management (24-47) and the outcome of patients who have suffered stroke (48-72). This article is protected by copyright. All rights reserved

Effect of Parkinson ‘s disease on driving- Implication of executive functions

L’objectif de cette thèse était d’étudier les fonctions exécutives dans la maladie de Parkinson et leurs implications dans la conduite automobile. Nous avons mesuré séparément les fonctions de flexibilité mentale et de mise à jour par des tests neuropsychologiques et des tâches sur simulateur de conduite. Nous avons fait l’hypothèse que ces fonctions étaient plus altérées chez les patients et que leurs déficits influençaient la performance de conduite. Trois études ont été réalisées : les deux premières sur simulateur et la dernière sur route avec un véhicule instrumenté. Les résultats de la première étude ont montré un déficit de la fonction de mise à jour chez les patients par rapport aux contrôles. La deuxième étude consistait à tester une seconde fois les conducteurs deux ans après la première étude. En deux ans, la fonction de flexibilité s’est dégradée chez les patients, suggérant que les deux fonctions étudiées ont évolué différemment : la mise à jour étant atteinte plus précocement dans la maladie. Les patients déclaraient également avoir restreint leur conduite. Les résultats de la troisième étude sur route ont permis d’identifier les conducteurs parkinsoniens à « risque » d'être dangereux, i.e. ceux ayant le plus de difficultés en conduite (évaluation conjointe de l’expérimentateur et du moniteur d’auto-école). Les conducteurs à « risque » avaient des performances plus faibles aux tests de mise à jour et de flexiblité par rapport aux conducteurs parkinsoniens sécuritaires. L’ensemble de ces travaux mettent en évidence le rôle essentiel de la mise à jour et de la flexibilité mentale dans la conduite automobile chez des personnes atteintes de la maladie de Parkinson.The objective of this thesis was to investigate executive functions in Parkinson’s disease and their implications on driving. We have chosen to separately assess mental flexibility and updating information in working memory by neuropsychological tests and driving simulator tasks. We tested the hypothesis that these two executive functions were impaired in patients and that their deficits influenced the driving performance. Three studies were realised: the first two used the driving simulator and the last was performed on-road with an instrumented vehicle. Results of the first study have shown an updating impairment in patients compared to controls. The second study consisted of assessing the drivers a second time two years after the first study. In two years, the flexibility function declined in patients, suggesting that the two selected functions did not change in a similar way: updating is affected earlier in the disease than mental flexibility. Also, patients declared to have restricted their driving. Results of the third on-road study allowed us to identify “at-risk” drivers with Parkinson’s disease, that is to say those having the most driving difficulties (assessment from both experimenter and a driving instructor). At-risk drivers had poorer performances in updating and flexibility tasks compared to “safe” drivers. All of these studies emphasised the essential role of updating and mental flexibility in driving in people with Parkinson’s disease

Effet de la maladie de Parkinson sur la conduite automobile (Implication des fonctions exécutives)

L objectif de cette thèse était d étudier les fonctions exécutives dans la maladie de Parkinson et leurs implications dans la conduite automobile. Nous avons mesuré séparément les fonctions de flexibilité mentale et de mise à jour par des tests neuropsychologiques et des tâches sur simulateur de conduite. Nous avons fait l hypothèse que ces fonctions étaient plus altérées chez les patients et que leurs déficits influençaient la performance de conduite. Trois études ont été réalisées : les deux premières sur simulateur et la dernière sur route avec un véhicule instrumenté. Les résultats de la première étude ont montré un déficit de la fonction de mise à jour chez les patients par rapport aux contrôles. La deuxième étude consistait à tester une seconde fois les conducteurs deux ans après la première étude. En deux ans, la fonction de flexibilité s est dégradée chez les patients, suggérant que les deux fonctions étudiées ont évolué différemment : la mise à jour étant atteinte plus précocement dans la maladie. Les patients déclaraient également avoir restreint leur conduite. Les résultats de la troisième étude sur route ont permis d identifier les conducteurs parkinsoniens à risque d'être dangereux, i.e. ceux ayant le plus de difficultés en conduite (évaluation conjointe de l expérimentateur et du moniteur d auto-école). Les conducteurs à risque avaient des performances plus faibles aux tests de mise à jour et de flexiblité par rapport aux conducteurs parkinsoniens sécuritaires. L ensemble de ces travaux mettent en évidence le rôle essentiel de la mise à jour et de la flexibilité mentale dans la conduite automobile chez des personnes atteintes de la maladie de Parkinson.The objective of this thesis was to investigate executive functions in Parkinson s disease and their implications on driving. We have chosen to separately assess mental flexibility and updating information in working memory by neuropsychological tests and driving simulator tasks. We tested the hypothesis that these two executive functions were impaired in patients and that their deficits influenced the driving performance. Three studies were realised: the first two used the driving simulator and the last was performed on-road with an instrumented vehicle. Results of the first study have shown an updating impairment in patients compared to controls. The second study consisted of assessing the drivers a second time two years after the first study. In two years, the flexibility function declined in patients, suggesting that the two selected functions did not change in a similar way: updating is affected earlier in the disease than mental flexibility. Also, patients declared to have restricted their driving. Results of the third on-road study allowed us to identify at-risk drivers with Parkinson s disease, that is to say those having the most driving difficulties (assessment from both experimenter and a driving instructor). At-risk drivers had poorer performances in updating and flexibility tasks compared to safe drivers. All of these studies emphasised the essential role of updating and mental flexibility in driving in people with Parkinson s disease.LYON2/BRON-BU (690292101) / SudocSudocFranceF