No Evidence to Support Periodic Driving Reassessment for Parkinson Disease

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The driving-test failure rate for on-the-road tests was 6 times higher for patients with Parkinson’s.
The driving-test failure rate for on-the-road tests was 6 times higher for patients with Parkinson’s.

Although patients with Parkinson disease (PD) demonstrate substantial driving impairment, self-reported crash data does not support mandated PD-specific periodic driving reassessment, according to results published in Neurology.

The researchers searched 7 databases through January 2018. They included studies that compared participants with PD with healthy controls on overall driving performance. Data were analyzed using random-effects meta-analysis.

A total of 50 studies that included 5410 participants (1955 with PD, 3455 healthy controls) met the eligibility criteria.

The researchers found that participants with PD had higher odds of on-the-road test failure (odds ratio [OR] 6.16; 95% CI, 3.79-10.03; P<.001) and simulator crashes (OR 2.63; 95% CI, 1.64-4.22; P=.008) compared with healthy controls. Participants with PD had a higher likelihood of simulator crashes (OR 2.63; 95% CI, 1.64-4.22; P=.008).  Participants with PD also had worse overall driving ratings compared with controls (standardized mean differences from 0.50 to 0.67).

Despite these results, the rate of self-reported, real-life crash involvement did not differ between participants with PD and health controls (OR 0.84; 95% CI, 0.57-1.23; P=.38). After adjusting for differences in age, sex, and driving exposure, the findings remained consistent. Additionally, the researchers did not find a moderating influence of disease severity.

“These results do little to support mandated periodic driving reassessment for patients with PD based on currently available evidence, and encourage thorough individualized assessment as the most appropriate method for determining fitness to drive,” the researchers wrote.

Reference

Thompson T, Poulter D, Miles C, et al.­ Driving impairment and crash risk in Parkinson disease: a systematic review and meta-analysis [published online August 3, 2018]. Neurology. doi:10.1212/WNL.0000000000006132

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