Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

Background: Driving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility. Methods: Patients with cognitive impairment (n= 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using abinary logistic regression analysis. Use of alternative transportation was also evaluated. Results: Respectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency ofcycling and/or public transport use. Conclusions: Adherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment

Assessing fitness to drive:A validation study on patients with mild cognitive impairment

Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.</p

Speed characteristics of speed pedelecs, pedelecs and conventional bicycles in naturalistic urban and rural traffic conditions

To assess the potential impact of the higher speeds of pedal-assisted bicycles on safety, this study compared conventional bicycles, pedelecs and speed pedelecs (hereafter called s-pedelecs) on mean speeds, speed variability, harsh braking events (decelerations > 2 m/s), and mean speeds above the speed limit (MSAL) in rural and urban areas in the Netherlands Data were collected in daily traffic, while the legal maximum speed for speed-pedelecs was 25 km/h, and pedelecs and s-pedelecs shared the infrastructure with conventional bicycles. Data were collected, using two-wheelers equipped with accelerometers and GPS. Personality factors – sensation seeking and risk taking - were measured with surveys. Regular commuters used one of the three bicycle types for two weeks. Participant bias was intentionally included by allowing participants to select a bicycle type of their preference, resulting in 12 conventional bicycle riders (71 % women), 14 pedelec riders (67 % women) and 20 s-pedelec riders (25 % women). S-pedelecs were much faster than conventional bicycles, amounting to a speed difference with conventional bicycles of 10.4 km/h in urban areas (M =28.2 km/h vs. 17.8 km/h) and of 13.2 km/h in rural areas (M = 31.4 km/h vs. 18.2 km/h). The speed differences between pedelecs and conventional bicycles were much smaller: 2.3 km/h in urban areas (20.1 km/h vs 17.8 km/h) and 4 km/h in rural areas (22.2 km/h vs. 18.2 km/h). Compared to conventional bicycles, s-pedelecs varied their speed to a greater extent and also braked harshly more frequently, showing a greater need for speed adjustment. These adjustments were larger at higher speeds. In contrast, pedelecs did not differ from conventional bicycles on speed variation. MSAL for s-pedelec riders differed by gender. For men the MSAL was 87 % on urban sections and 91 % on rural sections. For women, the MSAL was lower, respectively 23 and 69 %. None of the personality factors were associated with speed variability, harsh braking or MSAL. However, sensation seeking was associated with higher mean speeds on all three bicycle types. To conclude, pedelecs and conventional bicycles are similar in speed patterns, whereas the speed patterns of s-pedelecs differ significantly from the former two. The safety implications are discussed.</p

Corrigendum to “Speed characteristics of speed pedelecs, pedelecs and conventional bicycles in naturalistic urban and rural traffic conditions” [Accid. Anal. Prev. 150 (2021) 105940] (Accident Analysis and Prevention (2021) 150, (S0001457520317607), (10.1016/j.aap.2020.105940))

The authors regret that a mistake was made in Table 3 of the article. This table should read: [Table presented] The figures in bold, italic and red differ from the figures in the published article. As a result of these different values, the sixth sentence of the abstract should read: “S-pedelecs were much faster than conventional bicycles, amounting to a speed difference with conventional bicycles of 9.6 km/h in urban areas (M = 26.9 km/h vs. 17.3 km/h) and of 13.1 km/h in rural areas (M = 31.4 km/h vs. 18.3 km/h).” and the seventh sentence of the abstract should read: “The speed differences between pedelecs and conventional bicycles were much smaller: 2.8 km/h in urban areas (20.1 km/h vs 17.3 km/h) and 3.9 km/h in rural areas (22.2 km/h vs. 18.3 km/h). In the Discussion, Section 4.1. Comparison with previous studies on cycling speed characteristics, the second sentence of the second section should read: “Our study found similar patterns among Dutch riders. S-pedelecs were much faster than conventional bicycles, amounting to a speed difference in mean speeds in urban areas of 9.6 km/h (M = 26.9 km/h vs. 17.3 km/h) and in rural areas of 13.1 km/h (M = 31.4 km/h vs. 18.3 km/h). Values different from those in the published text are in bold, italic, and red. The authors would like to apologise for any inconvenience caused.</p

Welke modi van vervoer gebruiken mensen met dementie?

Dementie is een risicofactor voor onveilig rijgedrag. Het lijkt daarom logisch dat mensen met dementie niet autorijden, en vroeger was dit ook zo vastgelegd in de wet. Onderzoek wijst echter uit dat niet alle mensen met dementie onveilig rijden en dat er een grote groep mensen met dementie is die nog meerdere jaren kan blijven rijden nadat de diagnose gesteld is. Naar aanleiding van dergelijk onderzoek, is de wet inmiddels aangepast en mogen mensen met lichte dementie blijven autorijden als ze geslaagd zijn voor een rijtest bij het CBR. Een deel van de patiënten slaagt echter niet voor deze rijtest en zij verliezen hun rijbewijs. Vooral voor deze groep mensen is het een relevante vraag hoe ze mobiel kunnen blijven zonder zelf auto te rijden. Er zijn veel alternatieve vervoerswijzen, zoals fietsen en lopen, het openbaar vervoer gebruiken, een taxi nemen, een langzaam gemotoriseerd vervoersmiddel besturen, enzovoort. Dit betekent echter niet dat al deze vervoerswijzen ook gebruikt worden door deze mensen. Het huidige onderzoek betreft een groep mensen met dementie die zijn onderzocht op hun geschiktheid om auto te rijden. Dit is onderzocht met een uitgebreide methode, inclusief een rijtest van het CBR. Na dit onderzoek zijn de deelnemers geadviseerd om al of niet te blijven autorijden. Enkele maanden later is aan alle deelnemers gevraagd welke modi van vervoer ze op dat moment gebruikten. In de presentatie zal behandeld worden welke vervoerswijzen gebruikt worden door mensen met dementie die zelf autorijden en door mensen met dementie die niet meer zelf autorijden. Een voorbeeld van een logisch resultaat is dat mensen met dementie die zelf autorijden minder gebruik maken van taxi’s dan mensen met dementie die niet meer zelf autorijden, maar er zijn meer verschillen in de modi van vervoer tussen de autorijders en niet-autorijders met dementie. Een kwestie van (psycho)logisch nadenken? Voor iedereen, ook voor mensen met dementie, is mobiliteit erg belangrijk om te kunnen participeren in de samenleving. Voor mensen met dementie is mobiliteit echter minder vanzelfsprekend, omdat niet alleen autorijden maar ook het gebruik van andere vervoerswijzen lastiger kan worden. De resultaten van dit onderzoek geven een belangrijk basis voor diverse discussievragen. Bijvoorbeeld, hoe mobiel zijn mensen met dementie? Hebben ze hulp nodig bij het kiezen voor verschillende modi van vervoer? Kunnen we ze mobieler maken, en (hoe) kan dit op een veilige manier

Replication Data for: Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

Background: Driving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility. Methods: Patients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated. Results: Respectively 92% and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use

Replication Data for: Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

Background: Driving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility. Methods: Patients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated. Results: Respectively 92% and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use

DNA damage and signalling pathways in cellular senescence

Organisms such as mammals need tissue renewal as an important process for maintenance of their viability. Because proliferation is essential also for tumourigenesis, cells need tumour-suppressor mechanisms to protect organism against cancer. Cellular senescence, the permanent state of cell-cycle arrest, features one of these intrinsic barriers against tumourigenesis after DNA damage and understanding of this process may lead to finding of novel therapeutic targets and to optimization of chemotherapy for patients with cancer. In the first part of the PhD thesis, we investigated activation of JAK/STAT signalling pathway in drug-induced senescence. We used genotoxic drugs like aphidicolin, camptothecine, 5-bromo- 2'-doexyuridin, etoposide or thymidine to induce premature senescence in normal and cancer cells. All this chemicals were able to persistently activate JAK/STAT signalling in monitored cells. Activation of STATs was accompanied with up-regulation of expression of interferon-stimulated genes (ISGs), such as MX1, IRF1, IRF7 and PML. Since IRF1 and IRF7 can be directly involved in stimulation of the IFN genes, we show activated expression as well as secretion of IFNbeta and IFNgamma, but not IFNalpha in drug-induced senescent cells. Furthermore, an inhibition of JAK1 as a major kinase of STAT..

Driving difficulties among patients with Alzheimer's disease and other neurodegenerative disorders

BACKGROUND/OBJECTIVE: Neurodegenerative disorders impact fitness to drive of older drivers, but on-road driving studies investigating patients with different neurodegenerative disorders are scarce. A variety of driving errors have been reported in patients with Alzheimer's disease (AD), but it is unclear which types of driving errors occur most frequently. Moreover, patients with other neurodegenerative disorders than AD typically present with different symptoms and impairments, therefore different driving errors may be expected. METHODS: Patients with AD (n = 80), patients with other neurodegenerative disorders with cognitive decline (i.e., vascular dementia, frontotemporal dementia, dementia with Lewy bodies/Parkinson's disease, n = 59), and healthy older drivers (n = 45) participated in a fitness-to-drive assessment study including on-road driving. RESULTS: Patients with AD performed significantly worse than healthy older drivers on operational, tactical, visual, and global aspects of on-road driving. In patients with AD, on-road measures were significantly associated with 'off-road' measures. Patients with neurodegenerative disorders other than AD showed large overlap in the types of driving errors. Several driving errors were identified that appear to be characteristic for patients with particular neurodegenerative disorders. CONCLUSION: Patients from each group of neurodegenerative disorders commonly display tactical driving errors regarding lane positioning, slow driving, observation of the blind spot, and scanning behavior. Several other tactical and operational driving errors, including not communicating with cyclists and unsteady steering, were more frequently observed in patients with non-AD neurodegenerative disorders. These findings have implications for on-road and 'off-road' fitness-to-drive assessments for patients with neurodegenerative disorders with cognitive decline