Impaired navigation in drivers with Parkinson's disease

Abstract

Navigating a new route during automobile driving uses the driver's cognitive resources and has the potential to impair driving ability in people with Parkinson's disease (PD). Our aim was to assess navigation and safety errors during a route following task (RFT) in drivers with the illness. Seventy-seven subjects with mild-moderate PD (median Hoehn-Yahr stage = 2.0) and 152 neurologically normal elderly adults, all active and licensed drivers, were tested with a battery of visual, cognitive and motor tests of abilities. Each driver also performed a RFT administered on the road in an instrumented vehicle. Main outcome variables included: number of incorrect turns, times lost and at-fault safety errors. All group comparisons were adjusted for age, gender, education and familiarity with the region. Drivers with PD performed significantly worse on cognitive, visual and motor tests compared to controls, and took longer to finish the RFT. Higher proportions of these drivers made incorrect turns {53.9% in PD versus 21.1% in controls, Odds Ratio (OR) [95% Confidence Interval (CI)] = 2.8 [1.4, 5.7], P = 0.006}, got lost (15.8% versus 2.0%, OR [95%CI] = 4.7 [1.1, 20.0], P = 0.037), or committed at-fault safety errors (84.2% versus 46.7%, OR [95%CI] = 7.5 [3.3, 17.0], P < 0.001). Within the patient group, the navigational and safety errors were predicted by poor performances on cognitive and visual tests, but not by the severity of motor dysfunction. Drivers with PD made more navigation and safety errors than neurologically normal drivers on a RFT that placed demands on driver memory, attention, executive functions and visual perception. The PD group driver safety was degraded possibly due to an increase in the cognitive load in patients with limited reserves. Navigational errors and lower driver safety were associated more with impairments in cognitive and visual function than the motor severity of their disease in drivers with PD.