Handbook of Driving Simulation for Engineering, Medicine, and Psychology

Driving in Alzheimer’s Disease, Parkinson’s Disease, and Stroke

Authors
Ergun Uc, The University of Iowa
Matthew Rizzo, The University of Iowa

Abstract
The Problem. The proportion of elderly in the general population is projected to rise, with corresponding increases in age-related neurodegenerative conditions such as Alzheimer’s disease (AD) or Parkinson’s disease (PD), and stroke. These disorders impair perception, cognition, and motor function, leading to reduced driver fitness and increased crash risk. Medical diagnosis or age alone is not reliable enough to predict driver safety or crashes and there is no effective rehabilitation for these drivers. Role of Driving Simulators. Driving simulators can help characterize patterns of driver error in a roadway environment that are challenging but safe compared to driving on the open road. There is preliminary evidence that simulators can be used in driver rehabilitation in neurological disorders (e.g., stroke). Key Results of Driving Simulator Studies. Driving simulators have been used to discriminate between the performance of drivers with AD, PD, and stroke and comparison drivers of similar age without neurological disease. Impairments in cognition, visual perception, and motor function have been the main predictors of poor simulated driving outcomes. Scenarios and Dependent Variables. A number of scenarios and the dependent variables can be used to differentiate between normal older drivers and those with PD, AD, and stroke, depending on the specific questions to be answered. Platform Specificity and Equipment Limitations. Scenarios to discriminate between safe and unsafe drivers with neurological disease can be implemented on a variety of simulators. The relationships between performance on these different platforms and real-world driving performance is under study.

Keywords
Alzheimer’s Disease, Parkinson’s Disease, Stroke, Cerebrovascular Disease, Cognition, Dementia, Visual Perception

Key Points
• AD, PD, and stroke affect driving performance by impairing cognition, visual perception, mood, and motor function. Medication side effects may complicate the driving performance by increasing sleepiness, and causing thought and impulse problems.
• Scenario design should aim at discerning the effect of cognitive, visual, and motor deficits on driving in these conditions and should take practical difficulties of implementation into consideration.
• Driving simulators have been able to differentiate between controls and drivers with AD, PD, or stroke, and have helped to characterize driving impairments and understand the mechanisms of driver error in these disorders.
• Driving simulators may help in assessing driver fitness and rehabilitating impaired drivers, however further research is needed to validate their predictive ability in real-life driving and driver rehabilitation potential.

Web Resources
Supplemental text containing descriptions and related figures, for the following:
• Iowa Driving Simulator (IDS)
• IDS illegal intersection incursion scenario description
• SIREN (Simulator for Interdisciplinary Research in Ergonomics and Neuroscience)
• Rear-end collision scenario
• Stolwyk et al. (2005): The simulator description and study design
• The CARA simulator used in article on Parkinson’s Disease (Devos et al., 2007)and
stroke (Akinwuntan et al., 2005)

Key Readings
Akinwuntan, A. E., De Weerdt, W., Feys, H., Pauwels, J., Baten, G., Orno, P., et al. (2005). Effect of simulator training on driving after stroke: A randomized controlled trial. Neurology, 65, 843–850.

Rizzo, M., and Eslinger, P. J. (Eds.). (2004). Principles and practice of behavioral neurology and neuropsychology. Philadelphia, PA: WB Saunders.

Stolwyk, R. J., Triggs, T. J., Charlton, J. L., Iansek, R., Bradshaw, J. L. (2005). Impact of internal versus external cueing on driving performance in people with Parkinson’s disease. Movement Disorders, 20, 846–857.

Uc, E. Y., Rizzo, M., Anderson, S. W., Shi, Q., and Dawson, J. D. (2006a). Unsafe rear-end collision avoidance in Alzheimer’s disease. Journal of Neurological Sciences, 251, 35–43.