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Aims: In this study, we investigated if health professionals' evaluations of driving ability corresponded with measures of severity of alcohol use and measures of cognitive functions necessary for safely driving a car. Methods: A total of 90 participants from a multicentre study were included. Participants were categorised into three groups: (1) the group judged fit to drive (FIT); (2) the group judged not fit to drive (UNFIT); and (3) the group who had lost their driver's licence due to legal sanctions (LEGAL). The participants' AUDIT scores, earlier treatment episodes and results from neuropsychological tests of reaction time, attention and visuospatial ability were included in the analyses. Results: We found a significant difference in the severity of alcohol use disorder (AUD) and visuospatial abilities between the FIT and UNFIT groups. Half of the UNFIT group had at least mild visuospatial difficulties, compared to only a quarter in the FIT group. There were no group differences in reaction time or attentional measures. The LEGAL group had more severe AUD than the other groups. Conclusion: The FIT group did not perform differently from the UNFIT group on attention and reaction time measures. The UNFIT group had more visuospatial impairments, but even half of this group had normal scores. It is uncertain whether the differences between the two groups are of practical significance. The quality of health professionals' evaluations may be questioned, and the results highlight the need for more reliable and valid criteria for doing fitness to drive evaluations. [ABSTRACT FROM AUTHOR]

Background: Driving requires a series of cognitive abilities, many of which are affected by age and medical conditions. The psychosocial importance of continued driving ushers the need for valid measurements in fitness-to-drive assessments. A driving simulator test could prove useful in these assessments, having greater face validity than other off-road tests and being more costeffective and safer than ordinary on-road testing. The aim of this study was to validate a driving simulator test for assessment of cognitive ability in fitness-todrive assessments. Methods: The study included 67 healthy participants. Internal consistency of the simulator subtests was estimated. A correlation analysis between results on the simulator and the cognitive tests Trail Making Test (TMT) A and B and the Useful field of View test (UFOV) and multiple regression analysis were conducted. Finally, a comparison of results between age groups (>65 years) and (<65 years) was done. Results: Results showed good internal consistency. Significant and moderate correlations were found for all reaction time in the simulator's subtests and UFOV 3, and all but two with TMT A. Lane positioning in the simulator showed significant and low to moderate correlations with UFOV 3 in all subtests. Reaction time and Double reaction time on subtest 3 were significantly correlated with UFOV 2 and UFOV 3 and TMT A, respectively. Test on Centerline (position) in subtest 3 as dependent variable was significantly correlated with UFOV 3. Significant means differences and large effect sizes between the age groups were found for all reaction time and lane positioning tests. Conclusion: The findings of concurrent validity, especially with TMT A and UFOV 3 and its sensitivity for age-related differences, indicate potential for the simulator to be used as a complement in fitness-to-drive assessments. However, a clinical study is necessary to further examine its usefulness for patients with cognitive deficits. [ABSTRACT FROM AUTHOR]

The use of smartwatches has increased significantly in recent years for leisure, health, and research purposes. In the transport sector, smartwatches facilitate cost-effective, unintrusive, and dynamic monitoring of the driver’s state and behavior while on the road. This scoping review aimed to analyze and synthesize publications that have collected smartwatch data during driving to examine the driver’s condition, behavior, in-cabin activities, and reactions. The main objective was to assess the extent to which smartwatches have been included in driving-related studies, organize the relevant literature thematically, and identify the issues that arise during the collection and analysis of smartwatch data.A scoping review was conducted and 76 eligible records were identified based on the framework provided by Arksey and O’Malley. The publications differed significantly in terms of their main purposes, number of recruited participants, smartwatches used, and methodologies applied. Five main themes were identified in the relevant literature: driver state assessment, benchmark performance, driver assistance systems and interventions, exogenous and endogenous factors, and detection of driving events. The review confirms the potential of smartwatches as a tool for driver monitoring, which goes beyond the capabilities of questionnaires. Some studies reported data-related problems, mainly related to data loss and sweating. Future research should adopt a more comprehensive approach to driver monitoring by expanding the collection of data beyond the narrow context of the driving task to include measurements related to the long-term health of the driver, such as sleep, resting heart rate, and physical activity.

From 2016 onwards, a group of cardiologists initially formed in 2013 took the initiative to regulate and standardize the rights of European citizens suffering from diverse cardiovascular conditions at the European level. Subsequently, the Romanian government embraced and incorporated these recommendations into law a year later. This process addressed several important new aspects, including stents, myocarditis, and various cardiomyopathies, with a focus on striking a balance between the individual’s right to drive a vehicle and the need to safeguard the lives of others. The Romanian law, however, is vague and states that “candidates or drivers from the indicated groups can be issued or renewed their driving licenses only after the condition in question has been effectively treated and subject to the opinion issued by the specialist cardiology doctor and, depending on a case, by performing a periodic medical check” but does not clearly specify how and for how long and to whom exactly the driver’s license should be suspended. Interestingly, Switzerland, despite not being an EU member, developed its own set of recommendations three years later, drawing strong inspiration from the German guidelines, which in turn personalized its indications (being the European country with the most publications in this field). A refinement of the refinement, one could say. The indications are clear, precise, and structured in a point-by-point fashion. The purpose of this review is to explore the Swiss guidelines on fitness to drive in cardiovascular diseases interactively, with discussions on fictitious cases, in the hope that doctors will be able to become more familiar with these rigid and often interpretable indications and implement them in their daily practice.

BackgroundDriving requires a series of cognitive abilities, many of which are affected by age and medical conditions. The psychosocial importance of continued driving ushers the need for valid measurements in fitness-to-drive assessments. A driving simulator test could prove useful in these assessments, having greater face validity than other off-road tests and being more cost-effective and safer than ordinary on-road testing. The aim of this study was to validate a driving simulator test for assessment of cognitive ability in fitness-to-drive assessments.MethodsThe study included 67 healthy participants. Internal consistency of the simulator subtests was estimated. A correlation analysis between results on the simulator and the cognitive tests Trail Making Test (TMT) A and B and the Useful field of View test (UFOV) and multiple regression analysis were conducted. Finally, a comparison of results between age groups (>65 years) and (

Objective: The Trail Making Test (TMT) is commonly used worldwide to evaluate cognitive decline and car driving ability. However, it has received critique for its dependence on the Latin alphabet and thus, the risk of misclassifying some participants. Alphabet support potentially increases test validity by avoiding misclassification of executive dysfunction in participants with dyslexia and those with insufficient automatization of the Latin alphabet. However, Alphabet support might render the test less sensitive to set-shifting, thus compromising the validity of the test. This study compares two versions of the TMT: with and without alphabet support. Methods: We compared the TMT-A, TMT-B, and TMT-B:A ratios in two independent normative samples with (n = 220) and without (n = 64) alphabet support using multiple regression analysis adjusted for age and education. The sample comprised Scandinavians aged 70-84 years. Alphabet support was included by adding the Latin alphabet A-L on top of the page on the TMT-B. We hypothesized that alphabet support would not change the TMT-B:A ratio. Results: After adjusting for age and years of education, there were no significant differences between the two samples in the TMT-A, TMT-B, or the ratio score (TMT-B:A). Conclusion: Our results suggest that the inclusion of alphabet support does not alter TMT's ability to measure set-shifting in a sample of older Scandinavian adults. [ABSTRACT FROM AUTHOR]

Objective: Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk by increasing the risk of motor vehicle crashes (MVCs). The aim of this systematic review was to synthesize and critically appraise evidence on the risk of MVC for drivers with psychiatric disorders. Method: We conducted a systematic review of the MVC risk associated with psychiatric disorders using seven databases in November 2019. Two reviewers examined each study and extracted data. The National Heart, Lung, and Blood Institute Quality Assessment tools were used to assess each study's quality of evidence. Results: We identified 24 studies that met the inclusion criteria, including eight cohort, 10 case-control, and six cross-sectional designs. Quality assessment ratings were "Good" for four studies, "Fair" for 10, and "Poor" for 10. Self-report or questionnaires were used in place of objective measures of either MVC, psychiatric disorder, or both in 12 studies, and only seven adjusted for driving exposure. Fifteen studies reported an increased risk of MVC associated with psychiatric disorders, and nine did not. There was no category of disorder that was consistently associated with increased MVC risk. Conclusion: The available evidence is mixed, not of high quality, and does not support a blanket restriction on drivers with psychiatric disorder. An individualized approach, as recommended by international guidelines, should continue. Further research should include objective assessments of psychiatric disorders and MVC risk and adjust for driving exposure. [ABSTRACT FROM AUTHOR]

Driving under the influence of alcohol is one of the greatest dangers to the safety of road users not only in Germany, but across the rest of the world. An essential indicator for both punitive and corrective measures as well as for the prediction of recidivism is the blood alcohol concentration (BAC). This paper examines the relationships between BAC of first-time offenders, former drinking history, traffic related alcohol problem (TRAP), and the outcome of a medical-psychological assessment. The concept of TRAP combines syndromes from Alcohol Use Disorders (AUD) and a non-clinical delinquency category (drink and drive issue without AUD). It is in use for diagnostics among "hard core" alcohol-impaired offenders according to a diagnostic model which is applied in Germany and accepted by the legislator. The present study (N = 505) showed that a BAC of 0.11% upwards must be considered as a risk parameter for the identification of drivers with non-normative, and therefore traffic safety impairing drinking patterns. The importance of BAC as a risk indicator for road safety is underlined by significant correlations between BAC with drinking history and TRAP, but its prognostic value is poor, since BAC was unrelated to the outcome of the medical-psychological assessment. It could be demonstrated that TRAP severity increases with higher age, higher BAC, greater number of drinking days, higher occasion-related drinking amounts, and non-social drinking motivation (against stress and tension). Practical consequences are drawn regarding preconditions for re-issuing a driving licence.

Background: Too little sleep and the consequences thereof are a heavy burden in modern societies. In contrast to alcohol or illicit drug use, there are no quick roadside or workplace tests for objective biomarkers for sleepiness. We hypothesize that changes in physiological functions (such as sleep–wake regulation) are reflected in changes of endogenous metabolism and should therefore be detectable as a change in metabolic profiles. This study will allow for creating a reliable and objective panel of candidate biomarkers being indicative for sleepiness and its behavioral outcomes. Methods: This is a monocentric, controlled, randomized, crossover, clinical study to detect potential biomarkers. Each of the anticipated 24 participants will be allocated in randomized order to each of the three study arms (control, sleep restriction, and sleep deprivation). These only differ in the amount of hours slept per night. In the control condition, participants will adhere to a 16/8 h wake/sleep regime. In both sleep restriction and sleep deprivation conditions, participants will accumulate a total sleep deficit of 8 h, achieved by different wake/sleep regimes that simulate real-life scenarios. The primary outcome is changes in the metabolic profile (i.e., metabolome) in oral fluid. Secondary outcome measures will include driving performance, psychomotor vigilance test, d2 Test of Attention, visual attention test, subjective (situational) sleepiness, electroencephalographic changes, behavioral markers of sleepiness, changes in metabolite concentrations in exhaled breath and finger sweat, and correlation of metabolic changes among biological matrices. Discussion: This is the first trial of its kind that investigates complete metabolic profiles combined with performance monitoring in humans over a multi-day period involving different sleep–wake schedules. Hereby, we aim to establish a candidate biomarker panel being indicative for sleepiness and its behavioral outcomes. To date, there are no robust and easily accessible biomarkers for the detection of sleepiness, even though the vast damage on society is well known. Thus, our findings will be of high value for many related disciplines. Trial registration: ClinicalTrials.gov Identifier NCT05585515, released on 18.10.2022; Swiss National Clinical Trial Portal SNCTP000005089, registered on 12 August 2022. [ABSTRACT FROM AUTHOR]

Abstract Background With age, medical conditions impairing safe driving accumulate. Consequently, the risk of accidents increases. To mitigate this risk, Swiss law requires biannual assessments of the fitness to drive of elderly drivers. Drivers may prove their cognitive and physical capacity for safe driving in a medically supervised driving test (MSDT) when borderline cases, as indicated by low performance in a set of four cognitive tests, including e.g. the mini mental status test (MMST). Any prognostic, rather than indicative, relations for MSDT outcomes have neither been confirmed nor falsified so far. In order to avoid use of unsubstantiated rules of thumb, we here evaluate the predictive value for MSDT outcomes of the outcomes of the standard set of four cognitive tests, used in Swiss traffic medicine examinations. Methods We present descriptive information on age, gender and cognitive pretesting results of all MSDTs recorded in our case database from 2017 to 2019. Based on these retrospective cohort data, we used logistic regression to predict the binary outcome MSDT. An exploratory analysis used all available data (model 1). Based on the Akaike Information Criterion (AIC), we then established a model including variables age and MMST (model 2). To evaluate the predictive value of the four cognitive assessments, model 3 included cognitive test outcomes only. Receiver operating characteristics (ROC) and area under the curve (AUC) allowed evaluating discriminative performance of the three different models using independent validation data. Results Using N = 188 complete data sets of a total of 225 included cases, AIC identified age (p

Background: The multicenter, randomized, double-blind, parallel-group, phase IIIb CANNA-TICS (CANNAbinoids in the treatment of TICS) trial showed clear trends for improvement of tics, depression, and quality of life with nabiximols versus placebo in adult patients with Gilles de la Tourette syndrome and other chronic tic disorders. Although in general nabiximols was well tolerated, it is unclear whether treatment using this cannabis extract influences driving skills in patients with chronic tic disorders. Methods: Here we report results of the "Fitness to Drive" substudy of the CANNA-TICS trial. The key endpoint was fitness to drive as a binary criterion with a computerized assessment at baseline and after 9 weeks of stable treatment (week 13) with nabiximols or placebo. A patient was considered unfit to drive according to the German Federal Highway Research Institute guidelines. Results: In the substudy, a total of 64 patients (76.6% men, mean±standard deviation of age: 36.8±13.9) were recruited at two study sites. The number of patients who were fit to drive increased from 24 (55.8%) at baseline to 28 (71.8%) at week 13 among 43 patients treated with nabiximols, and decreased from 14 (66.7%) to 10 (52.6%) among 21 patients who received placebo. The risk difference (nabiximols - placebo) was 0.17 (95% confidence interval=-0.08 to 0.43) in favor of nabiximols. Specifically, only 2 of 24 (8.3%) patients in the nabiximols, but 4 of 14 (28.6%) patients in the placebo group changed for the worse from fit (at baseline) to unfit (at week 13) to drive, whereas 8 of 19 (42.1%) patients in the nabiximols, and only 2 of 7 (28.6%) patients in the placebo group improved from unfit to fit. Conclusion: Treatment with nabiximols does not impair skills relevant to driving in those patients with tic disorders who were fit to drive at baseline and even improved fitness to drive in a subset of patients who were unfit to drive before start of treatment. EudraCT number : 2016-000564-42.

Objective: The Swiss guidelines for driving with epilepsy require that electroencephalogram (EEG) findings must be compatible with the fitness to drive (FTD) without specifying any criteria. This nationwide survey investigated how Swiss neurologists implement this requirement in clinical practice., Methods: An online survey, including 19 EEG examples and statements about the compatibility of the EEG with FTD, was distributed to all members of the Swiss Society of Clinical Neurophysiology and all Swiss neurological clinics with residency programs. Descriptive statistics and Fleiss' Kappa for inter-rater agreement were performed., Results: 102 participants (37% female, 45% <45 years) completed the survey, with 15% primarily working in a specialized epileptology center (EPI), 55% in a hospital setting without epileptological focus (HOS), and 30% in private practice (PP). Most participants of all three groups regarded EEG normal variants as compatible with FTD, while hyperventilation-induced rhythmic slowing and some pathological patterns (e.g., frontal and temporal intermittent rhythmic delta activity [FIRDA, TIRDA], focal interictal epileptiform discharges [IED], focal seizure) were evaluated more heterogeneously. The EEG inter-rater agreement for EPI was 0.4; 0.31 for PP; and 0.24 for HOS. No consensus was found for acceptable duration for generalized or focal IEDs. Among all participants, evaluation by an epilepsy center (85%) and reaction-time testing (67%) were evaluated as the most useful additional examinations. However, reaction-time testing is rarely or never performed by 58%. Most supported EEG results as part of the FTD assessment and demanded more research (both 82%)., Significance: Our survey indicates considerable heterogeneity among Swiss neurologists when evaluating the EEG findings for FTD. Inter-rater agreement in all three groups was fair, with highest agreement among epileptologists. We noted a discrepancy between the usefulness and actual application of reaction-time testing. More training and research are warranted to achieve rater-independent consistency for FTD evaluation., Plain Language Summary: In Switzerland, neurologists must consider the findings from EEG (brain waves) exams to evaluate driving safety in people with epilepsy. We surveyed Swiss neurologists, asking their opinions on this matter. We found that opinions differ among individual doctors, with the highest agreement among epilepsy specialists. We also found that some additional tests, such as reaction-time testing, are perceived as useful but are rarely performed. The participating neurologists supported considering EEG results for driving fitness assessments but favored more precise guidelines and research., (© 2024 The Author(s). Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Background: This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world. Methods: The Arkesy and O’Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method. Results: Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation. Conclusion: Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

Driving under the influence of alcohol is one of the greatest dangers to the safety of road users not only in Germany, but across the rest of the world. An essential indicator for both punitive and corrective measures as well as for the prediction of recidivism is the blood alcohol concentration (BAC). This paper examines the relationships between BAC of first-time offenders, former drinking history, traffic related alcohol problem (TRAP), and the outcome of a medical-psychological assessment. The concept of TRAP combines syndromes from Alcohol Use Disorders (AUD) and a non-clinical delinquency category (drink and drive issue without AUD). It is in use for diagnostics among "hard core" alcohol-impaired offenders according to a diagnostic model which is applied in Germany and accepted by the legislator. The present study (N = 505) showed that a BAC of 0.11% upwards must be considered as a risk parameter for the identification of drivers with non-normative, and therefore traffic safety impairing drinking patterns. The importance of BAC as a risk indicator for road safety is underlined by significant correlations between BAC with drinking history and TRAP, but its prognostic value is poor, since BAC was unrelated to the outcome of the medical-psychological assessment. It could be demonstrated that TRAP severity increases with higher age, higher BAC, greater number of drinking days, higher occasion-related drinking amounts, and non-social drinking motivation (against stress and tension). Practical consequences are drawn regarding preconditions for re-issuing a driving licence. [ABSTRACT FROM AUTHOR]

Background: With age, medical conditions impairing safe driving accumulate. Consequently, the risk of accidents increases. To mitigate this risk, Swiss law requires biannual assessments of the fitness to drive of elderly drivers. Drivers may prove their cognitive and physical capacity for safe driving in a medically supervised driving test (MSDT) when borderline cases, as indicated by low performance in a set of four cognitive tests, including e.g. the mini mental status test (MMST). Any prognostic, rather than indicative, relations for MSDT outcomes have neither been confirmed nor falsified so far. In order to avoid use of unsubstantiated rules of thumb, we here evaluate the predictive value for MSDT outcomes of the outcomes of the standard set of four cognitive tests, used in Swiss traffic medicine examinations.Methods: We present descriptive information on age, gender and cognitive pretesting results of all MSDTs recorded in our case database from 2017 to 2019. Based on these retrospective cohort data, we used logistic regression to predict the binary outcome MSDT. An exploratory analysis used all available data (model 1). Based on the Akaike Information Criterion (AIC), we then established a model including variables age and MMST (model 2). To evaluate the predictive value of the four cognitive assessments, model 3 included cognitive test outcomes only. Receiver operating characteristics (ROC) and area under the curve (AUC) allowed evaluating discriminative performance of the three different models using independent validation data.Results: Using N = 188 complete data sets of a total of 225 included cases, AIC identified age (p < 0.0008) and MMST (p = 0.024) as dominating predictors for MSDT outcomes with a median AUC of 0.71 (95%-CI 0.57-0.85) across different training and validation splits, while using the four cognitive test results exclusively yielded a median AUC of 0.55 (95%-CI 0.40-0.71).Conclusions: Our analysis provided strong evidence for age as the single most dominant predictor of MSDT outcomes. Adding MMST provides only weak additional predictive value for MSDT outcomes. Combining the results of four cognitive test used as standard screen in Swiss traffic medicine alone, proved to be of poor predictive value. This highlights the importance of MSDTs for balancing between the mitigation of risks by and the right to drive for the elderly. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the effect of glaucomatous visual field defects on several neuropsychological tests that are often used in research and in clinical settings. Methods: Nineteen glaucoma patients and nineteen healthy participants, which are current drivers and older than 65 years old were included. All participants completed the Montreal Cognitive Assessment (MoCA), the Trail Making Test (TMT), the Benton Visual Retention Test (BVRT), the Snellgrove Maze Task (SMT) and the Digit Span Test (DST). All participants were also tested on contrast sensitivity and near and far visual acuity. For the glaucoma patients, visual field tests were downloaded from hospital servers. Results: On the MoCA test, glaucoma patients scored lower than the healthy group, but not significantly. On the MoCA‐Blind, the difference was statistically significant. Glaucoma patients also had lower percentile scores on the TMT, with a significant difference in the TMT‐A, but this difference largely disappeared in the calculated TMT B‐A index, which isolates the cognitive component. The BVRT and SMT showed no significant differences between both groups. In the only non‐visual test, the DST, glaucoma patients outperformed the healthy group. Glaucoma severity did not influence results, except for the BVRT on which the moderate/severe group has better scores. Conclusion: Using visual items might lead to conclusions about cognition when it should be one about vision. Therefore, careful selection of tests is needed when examining cognition in glaucoma patients. [ABSTRACT FROM AUTHOR]

The Directive (EU) 2015/653 aimed at facilitating that the maximum force that any disabled driver could make on the vehicle’s primary controls could be adjusted to their needs. The technical adjustment in the vehicle’s design requires a measurement of the operational forces applied by the driver on the steering and brake controls, in order to determine its functional capacity during the execution of driving manoeuvres. The objective of this paper is to define the steering and braking operative forces used for driving current-market M1 motor vehicles for the fitness to drive assessment of drivers with physical disabilities. A total of 200 trials were performed with 17 different vehicles and 26 drivers. The results obtained help to define a new threshold’s criteria for operative forces onto the steering and braking systems for adapting motor vehicles to disabled drivers. The main contribution of this paper consist on a new technical recommendations about the use of code 20.07 -braking- and 40.01 -steering- to be used in the fitness to drive assessment of driver with disabilities according to Directive (EU) 2015/653 requirements.

A pre-driving assessment usually involves standardised and non-standardised tests to examine the skills for safe driving of people with disabilities. However, it is still unknown to what extent the pre-driving assessments are being practised among occupational therapists in Malaysia. Therefore, this study aims to investigate the association of challenges, attitudes, and skills of occupational therapists towards practising driving rehabilitation and explore the most used predriving assessment. A cross-sectional study had been conducted from July to September 2020. The convenient sampling method was used to recruit experienced occupational therapists in driving rehabilitation. A total of 53 therapists had completed an online survey. According to the results, the bivariate correlation between skills and challenges was positive and strong (rs = 0.680, p < 0.05). A multivariate analysis of variance (MANOVA) indicated that workplace variables had a significant effect on the combined dependent variables of challenges, attitudes, and skills, F(3,49) = 4.521 p = 0.007, partial Ƞ² = 0.217. This study found that the most used standardised assessment was the range of motion (n = 39, 73.6 %) and the right and left discrimination (n = 40, 75.5 %). The findings of this study identified that occupational therapists challenges and attitudes are significantly associated with the skills to practice driving rehabilitation. Malaysian occupational therapists working in the government sector reported better skills than those working in the private sector. Furthermore, numerous types of pre-driving assessments were used and vary from setting to setting. This study hopes to benefit occupational therapists and related rehabilitation practitioners towards a holistic understanding of Malaysia's driving rehabilitation practices. [ABSTRACT FROM AUTHOR]

Aims: In this study, we investigated if health professionals' evaluations of driving ability corresponded with measures of severity of alcohol use and measures of cognitive functions necessary for safely driving a car. Methods: A total of 90 participants from a multicentre study were included. Participants were categorised into three groups: (1) the group judged fit to drive (FIT); (2) the group judged not fit to drive (UNFIT); and (3) the group who had lost their driver's licence due to legal sanctions (LEGAL). The participants' AUDIT scores, earlier treatment episodes and results from neuropsychological tests of reaction time, attention and visuospatial ability were included in the analyses. Results: We found a significant difference in the severity of alcohol use disorder (AUD) and visuospatial abilities between the FIT and UNFIT groups. Half of the UNFIT group had at least mild visuospatial difficulties, compared to only a quarter in the FIT group. There were no group differences in reaction time or attentional measures. The LEGAL group had more severe AUD than the other groups. Conclusion: The FIT group did not perform differently from the UNFIT group on attention and reaction time measures. The UNFIT group had more visuospatial impairments, but even half of this group had normal scores. It is uncertain whether the differences between the two groups are of practical significance. The quality of health professionals' evaluations may be questioned, and the results highlight the need for more reliable and valid criteria for doing fitness to drive evaluations., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: People with dizziness may experience driving-related limitations. Few data are available about the impact of dizziness on driving.Aim: The aim of this study is to investigate the impact of dizziness on driving, factors related to impairment (age, gender, and type of diagnosis), and the potential consequences for patients' ability to work. We also investigated whether the patients expected and actually received information about their dizziness-related fitness to drive from their physician.Methods: A cross-sectional, observational study was conducted in the Apeldoorn Dizziness Centre, a tertiary care referral centre for patients with dizziness. A consecutive cohort of patients was asked to complete a study-specific questionnaire about driving.Results: Between January 1, 2020, and December 20, 2020, 432 patients were included. Fifty-six percent of the patients in this group were female. The average age of patients was 58.3 years (SD 16). Overall, 191 of the 432 patients (44%) experienced limitations related to driving, and 40% of the patients who experienced limitations also experienced limitations to work related to their inability to drive. The subject of fitness to drive had not been discussed with their physician in 92% of the patients, and 24% of the whole patient group indicated that they would have liked to discuss this topic. The following factors, independently from each other, increased the chance of experiencing driving-related limitations: younger age, female sex, and the diagnosis of Meniere's disease.Conclusion: Dizzy patients, especially younger patients, women, and patients with Meniere's disease, regularly experience limitations related to driving, and this often means that they are unable to work. Driving is hardly ever discussed during a medical consultation. In our opinion, the topic of driving and dizziness should always be addressed during medical consultations in dizzy patients.

Background: People with dizziness may experience driving-related limitations. Few data are available about the impact of dizziness on driving. Aim: The aim of this study is to investigate the impact of dizziness on driving, factors related to impairment (age, gender, and type of diagnosis), and the potential consequences for patients' ability to work. We also investigated whether the patients expected and actually received information about their dizziness-related fitness to drive from their physician. Methods: A cross-sectional, observational study was conducted in the Apeldoorn Dizziness Centre, a tertiary care referral centre for patients with dizziness. A consecutive cohort of patients was asked to complete a study-specific questionnaire about driving. Results: Between January 1, 2020, and December 20, 2020, 432 patients were included. Fifty-six percent of the patients in this group were female. The average age of patients was 58.3 years (SD 16). Overall, 191 of the 432 patients (44%) experienced limitations related to driving, and 40% of the patients who experienced limitations also experienced limitations to work related to their inability to drive. The subject of fitness to drive had not been discussed with their physician in 92% of the patients, and 24% of the whole patient group indicated that they would have liked to discuss this topic. The following factors, independently from each other, increased the chance of experiencing driving-related limitations: younger age, female sex, and the diagnosis of Meniere's disease. Conclusion: Dizzy patients, especially younger patients, women, and patients with Meniere's disease, regularly experience limitations related to driving, and this often means that they are unable to work. Driving is hardly ever discussed during a medical consultation. In our opinion, the topic of driving and dizziness should always be addressed during medical consultations in dizzy patients. [ABSTRACT FROM AUTHOR]

Abstract The regulations for fitness to drive after a cerebrovascular accident in the German Driving License Regulations (FeV) and the German Evaluation Guidelines for Driving Ability (BGL). are not up to date with the current medical knowledge and not consistent with regulations regarding cardiovascular diseases. This position paper presented by six medical and neuropsychological societies in Germany provides a guideline for the assessment of driving ability after diagnosis of a cerebrovascular disease and addresses three major questions: If there is a functional limitation, how can it be compensated for? What is the risk of sudden loss of control while driving in the future? Are there behavioral or personality changes or cognitive deficiencies interfering with safety while driving? Recommendations for the assessment of driving ability in different cerebrovascular diseases are presented. This article is a translation of the position paper published in Nervenarzt: Marx, P., Hamann, G.F., Busse, O. et al. Nervenarzt 90(4): 388–398.

Literature on driving research suggests a relationship between cognition and driving performance in older and younger drivers. There is little research on adults and driving, despite them being the largest age cohort behind the wheel. Among the cognitive domains, visuospatial abilities are expected to be highly predictive of driving skills and driving fitness. The relationship between specific spatial mental transformation skills (i.e., object and self-based ones) and driving performance has not yet been examined. The present study aimed to investigate the relationship between overall cognitive functioning, self and object-based spatial mental transformation skills, and driving performance in a sample of younger and older adult drivers. Participants were comprised of one hundred younger and 83 older adult Italian drivers. Participants completed a computerized driving test assessing traffic stress resilience, visual and motor reaction time, and the ability to obtain an overview of the traffic scenario (DT, vRT, mRT, and ATAV respectively in the Shufried®-Vienna Test System–DRIVESC). The Mental Rotation Test (MRT) and the Object Perspective Taking Test (OPT) were administered in order to assess object-based and self-based spatial mental transformation skills. The Montreal Cognitive Assessment Test (MoCA) was administered control for global cognitive functioning. The effects of education and gender were also controlled in the analysis. The results of the present study suggested that: (1) The effect of age, favoring younger participants, was found in DT, vRT, mRT, and ATAVT tests. (2) The effect of global cognitive functioning was found in DT and ATAV tests. (3) The effect of the spatial mental transformation tests was found in DT, vRT (MRT only), and ATAVT (OPT only) tests. Taken together, these results suggest the specific contribution of spatial mental transformation skills in the execution of complex behaviors connected to the fitness to drive. Prospectively, the results of the present study relating spatial mental transformation skills and driving processes may be a valuable source of knowledge for researchers dealing with the relationship between cognitive resources and navigation aids.

Background Medical incapacity at the wheel is a small but significant factor in accident causation. To mitigate against this, in July 2017 a UK-based bus operator changed its medical assessment policy, requiring all future medicals to include a request to the General Practitioner (GP) for information about any conditions in the medical record which could affect fitness to drive. Aims To evaluate the impact of the change in policy on accident rates. Methods Accident data were obtained over a 5-year period, with information on age and length of service of drivers, from three bus depots. Monthly accident rates, before and after the change in policy were compared with the Wilcoxon matched pairs test, and a line of best fit/R2 obtained via a scatter graph. Results Although a general downward trend in accident rates was seen, there was no statistically significant difference between the overall accident rates in the 12 months before and after the policy change in July 2017 (P -value = 0.519, significance level P < 0.05). Conclusions The downward trend in accident rates observed over the study period could not be attributed to the change of policy. However, this intervention warrants further scrutiny due to the potential consequences of passenger service vehicle accidents. Evidence suggests that professional awareness of the UK Driver and Vehicle Licensing Agency fitness to drive standards can be limited, so requesting GP input into driver medicals may raise awareness of these standards from an occupational health perspective. [ABSTRACT FROM AUTHOR]

Introduction: Driver retirement and determination of fitness-to-drive are important aspects of reducing the risk of motor-vehicle collision for an older driver. A lack of information about the review process may lead to poor evaluation of drivers or an increased testing burden to referred drivers. Methods: This paper evaluates the license review process for the state of Iowa. We evaluated data from January 2014 to January 2018 and described the source of referral, testing process, and ultimate license disposition. Cox proportional hazards for competing risk were used to determine the risk of having a change in restrictions on the license and the risk of license denial. Results: 20,742 individuals were followed through the medical referral process. The most common source of referrals was licensing officials (39.7%). Drivers referred by licensing officials were less likely to be denied their license when compared to drivers from other sources (HR = 0.92 95%CI: 0.87–0.98); however, licensing official referrals were more likely to result in license restrictions compared to other sources (HR = 1.91, 95%CI: 1.82–2.00). Drivers referred by either law enforcement or a physician were more likely to ultimately have their license denied. Conclusions: Physician and law enforcement referred the drivers most likely to have their license denied. A smaller proportion of drivers were referred by physicians and law enforcement compared to licensing officials. Practical Applications: Licensing agencies should work with physicians and law enforcement to identify drivers who may need a review of their license. Comprehensive tracking of all medical referrals for a driver's license review is important for individual states to understand the burden of their driver referral process and for identifying referral sources with a high proportion of referrals with no licensing change for targeted outreach and education. [ABSTRACT FROM AUTHOR]

Literature on driving research suggests a relationship between cognition and driving performance in older and younger drivers. There is little research on adults and driving, despite them being the largest age cohort behind the wheel. Among the cognitive domains, visuospatial abilities are expected to be highly predictive of driving skills and driving fitness. The relationship between specific spatial mental transformation skills (i.e., object and self-based ones) and driving performance has not yet been examined. The present study aimed to investigate the relationship between overall cognitive functioning, self and object-based spatial mental transformation skills, and driving performance in a sample of younger and older adult drivers. Participants were comprised of one hundred younger and 83 older adult Italian drivers. Participants completed a computerized driving test assessing traffic stress resilience, visual and motor reaction time, and the ability to obtain an overview of the traffic scenario (DT, vRT, mRT, and ATAV respectively in the Shufried®-Vienna Test System–DRIVESC). The Mental Rotation Test (MRT) and the Object Perspective Taking Test (OPT) were administered in order to assess object-based and self-based spatial mental transformation skills. The Montreal Cognitive Assessment Test (MoCA) was administered control for global cognitive functioning. The effects of education and gender were also controlled in the analysis. The results of the present study suggested that: (1) The effect of age, favoring younger participants, was found in DT, vRT, mRT, and ATAVT tests. (2) The effect of global cognitive functioning was found in DT and ATAV tests. (3) The effect of the spatial mental transformation tests was found in DT, vRT (MRT only), and ATAVT (OPT only) tests. Taken together, these results suggest the specific contribution of spatial mental transformation skills in the execution of complex behaviors connected to the fitness to drive. Prospectively, the results of the present study relating spatial mental transformation skills and driving processes may be a valuable source of knowledge for researchers dealing with the relationship between cognitive resources and navigation aids. [ABSTRACT FROM AUTHOR]

• Evaluates the road safety impact of Ontario's medical fitness-to-drive policies. • Road safety losses were not incurred while medical cases were reviewed (2005–2014). • The intervention prevented an estimated 1,211 (95% CI: 780–1,730) collisions. • Interventional effect of the medical review program differed by medical condition. Introduction: Drivers with medical conditions and functional impairments are at increased collision risk. A challenge lies in identifying the point at which such risk becomes unacceptable to society and requires mitigating measures. This study models the road safety impact of medical fitness-to-drive policy in Ontario. Method: Using data from 2005 to 2014, we estimated the losses to road safety incurred during the time medically-at-risk drivers were under review, as well as the savings to road safety accrued as a result of licensing decisions made after the review process. Results: While under review, drivers with medical conditions had an age- and sex-standardized collision rate no different from the general driver population, suggesting no road safety losses occurred (RR = 1.02; 95% CI: 0.93–1.12). Licensing decisions were estimated to have subsequently prevented 1,211 (95% CI: 780–1,730) collisions, indicating net road safety savings resulting from medical fitness to drive policies. However, more collisions occurred than were prevented for drivers with musculoskeletal disorders, sleep apnea, and diabetes. We theorize on these findings and discuss its multiple implications. Conclusions: Minimizing the impact of medical conditions on collision occurrence requires robust policies that balance fairness and safety. It is dependent on efforts by academic researchers (who study fitness to drive); policymakers (who set driver medical standards); licensing authorities (who make licensing decisions under such standards); and clinicians (who counsel patients on their driving risk and liaise with licensing authorities). Practical Applications: Further efforts are needed to improve understanding of the effects of medical conditions on collision risk, especially for the identified conditions and combinations of conditions. Results reinforce the value of optimizing the processes by which information is solicited from physicians in order to better assess the functional impact of drivers' medical conditions on driving and to take suitable licensing action. [ABSTRACT FROM AUTHOR]

Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors’ keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.

The study of the contribution of spatial transformation skills to driving behavior is a research topic substantiated by scarce evidence. In previous studies, we found that mental rotation and perspective-taking skills have an influence on performance in driving tasks by conveying the distal effects of the general cognitive efficiency on the execution of driving maneuvers. Studies have provided evidence on the relevance of the cognitive processes of encoding, imagined rotation, and spatial orientation in the accuracy of both the vehicle management during stressful driving situations and the acquisition of visual information on the traffic scenario. Results can find applications in both the training and the assessment of fitness to drive, as well as in the study of interaction between the drivers and in-vehicle devices. The lack of cross-validations in path analysis models cannot be assumed, a priori, to be capitalizing on chance and as an example of bad science. The non-replicability of a study should be demonstrated before it is proclaimed. The purpose of this reply was to address the questions raised by Kelly et al. (2022)—that is, “Do these results seem replicable?” and “How do these results advance our understanding of brain function and/or human behavior?”—by providing additional information on the study in question.

Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic. [ABSTRACT FROM AUTHOR]

Study Objectives: Microsleep episodes (MSEs) are short fragments of sleep (1–15 s) that can cause dangerous situations with potentially fatal outcomes. In the diagnostic sleep-wake and fitness-to-drive assessment, accurate and early identification of sleepiness is essential. However, in the absence of a standardised definition and a time-efficient scoring method of MSEs, these short fragments are not assessed in clinical routine. Based on data of moderately sleepy patients, we recently developed the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring of MSEs and corresponding machine learning algorithms for automatic MSE detection, both mainly based on the electroencephalogram (EEG). The present study aimed to investigate the relationship between automatically detected MSEs and driving performance in a driving simulator, recorded in parallel with EEG, and to assess algorithm performance for MSE detection in severely sleepy participants. Methods: Maintenance of wakefulness test (MWT) and driving simulator recordings of 18 healthy participants, before and after a full night of sleep deprivation, were retrospectively analysed. Performance of automatic detection was compared with visual MSE scoring, following the BERN criteria, in MWT recordings of 10 participants. Driving performance was measured by the standard deviation of lateral position and the occurrence of off-road events. Results: In comparison to visual scoring, automatic detection of MSEs in participants with severe sleepiness showed good performance (Cohen's kappa = 0.66). The MSE rate in the MWT correlated with the latency to the first MSE in the driving simulator (r s = −0.54, p < 0.05) and with the cumulative MSE duration in the driving simulator (r s = 0.62, p < 0.01). No correlations between MSE measures in the MWT and driving performance measures were found. In the driving simulator, multiple correlations between MSEs and driving performance variables were observed. Conclusion: Automatic MSE detection worked well, independent of the degree of sleepiness. The rate and the cumulative duration of MSEs could be promising sleepiness measures in both the MWT and the driving simulator. The correlations between MSEs in the driving simulator and driving performance might reflect a close and time-critical relationship between sleepiness and performance, potentially valuable for the fitness-to-drive assessment. [ABSTRACT FROM AUTHOR]

Background Guidelines to provide recommendations about driving restrictions for patients with brain metastases are lacking. We aim to determine whether clinical neurologic examination is sufficient to predict suitability to drive in these patients by comparison with an occupational therapy driving assessment (OTDA). Methods We prospectively evaluated the concordance between neurology assessment of suitability to drive (pass/fail) and OTDA in 41 individuals with brain metastases. Neuro-oncology evaluation included an interview and neurological examination. Participants subsequently underwent OTDA during which a battery of objective measures of visual, cognitive, and motor skills related to driving was administered. Results The mean age of patients who failed OTDA was age 68.9 years vs 59.3 years in the group members who passed (P =.0046). The sensitivity of the neurology assessment to predict driving fitness compared with OTDA was 16.1% and the specificity 90%. The 31 patients who failed OTDA were more likely to fail Vision Coach, Montreal Cognitive Assessment, and Trail Making B tests. Conclusions There was poor association between the assessment of suitability to drive by neurologists and the outcome of the OTDA in patients with brain metastases. Subtle deficits that may impair the ability to drive safely may not be evident on neurologic examination. The positive predictive value was high to predict OTDA failure. Age could be a factor affecting OTDA performance. The results raise questions about the choice of assessments in making recommendations about driving fitness in people with brain metastases. OTDA should be strongly considered in patients with brain metastases who wish to continue driving. [ABSTRACT FROM AUTHOR]

Mental illness often leads to functional deficits that likely affect one's driving performance and may even pose threat to other road users. However, having a mental illness does not automatically preclude one from driving which is essential to mobility and productivity. Indeed, evaluating their fitness-to-drive would be of necessary. Despite that, there is still a lack of a local driving evaluation service that specifically addresses the impact of mental illness on driving capacity. This paper discusses the needs to evaluate the fitness-to-drive of people with mental illness. It advocates the development of such specific driver assessment service with a local example as illustration. Lastly, some of the challenges related to the drivers' responsibility to declare personal health status and large variety of assessment approaches are also discussed. [ABSTRACT FROM AUTHOR]

Introduction: The Fitness-to-Drive Screening Measure is a free online screening tool that detects at-risk older drivers, however, it's 20 min administration time may render the 54-item tool less than optimal for clinical use. Thus, this study constructed and validated a 21-item FTDS Short-Form (FTDS-SF).Method: This mixed methods study used 200 proxy rater responses and older driver on-road assessments. We conducted a Rasch analysis to examine information at the level of the item and used content validity index scores to select items. Using a receiver operator characteristics curve we determined the concurrent validity of the FTDS-SF to on-road outcomes.Results: Twenty-one items were selected for the FTDS-SF. The area under the curve = 0.72, indicated the FTDS-SF predicted on-road outcomes with acceptable accuracy. Still, 68 drivers were misclassified.Conclusion: The FTDS-SF may reduce administration time, while still yielding acceptable psychometric properties. Yet, caution needs to be executed in clinical decision making as the measure is overly specific.

Background Taxi driving has been associated with the risk of various diseases (e.g. cardiovascular disease, hypertension, diabetes, hyperlipaemia, back pain). Little is known about the relationship between health conditions and driving fitness of older taxi drivers who continue to work. Aims To investigate the (i) prevalence of medical conditions and (ii) relationship between age and medical conditions, with on-road driving tests in the relicensing process of older taxi drivers aged ≥70 years, prior to the mandatory retirement age of 75 years. Methods We analysed retrospectively all relicensing records (N = 855) of taxi drivers aged 70, 73 and 74 years that were submitted from April 2014 to April 2015. Results All passed their medical fitness screening. Ninety-eight per cent passed their driving tests. Thirty-one per cent, 36% and 24% reported none, one and two medical conditions, respectively. These included hypertension (56%), eye disease (25%; cataracts 19%), diabetes (24%), corrected hearing impairment (14%), hyperlipaemia (12%) and heart disease (9%). Deafness (P < 0.001) was associated with older age. No past medical condition affected driving outcome. Conclusion Older Singaporean taxi drivers were healthy and generally competent drivers. Early effective preventive health screening and modifiable lifestyle intervention are recommended in older taxi drivers. [ABSTRACT FROM AUTHOR]

Objective: Obstructive sleep apnoea syndrome (OSAS) associated with daytime sleepiness (DS) contributes to a higher incidence of motor vehicle accidents. Validation of fitness to drive in driving license applicants, with special concern regarding OSAS accompanied by excessive DS, became mandatory under new EU legislation in January 2016. The aim of the study was to translate and validate the recommended questionnaire to screen for OSAS (Q-OSAS) in the Slovak population. No data on any Q-OSAS validation has previously been published.Methods: The translated Q-OSAS was administered to 311 Slovak patients prior to a planned overnight polysomnography. The diagnostic accuracy of the Q-OSAS in OSAS with an apnoea-hypopnoea index of 15 or more/h of sleep was evaluated by calculating the area under the ROC curve.Results: The sensitivity and specificity of the cut-off at 10 points for the Q-OSAS was 57% and 67%, respectively, with an increase of sensitivity and a decrease of specificity with a lowering of the cut-off values. Excluding the Epworth Sleepiness Scale (ESS) score from the final statistics yielded the best sensitivity (77%), specificity (50%), and an area under the ROC curve (0.637) for the cut-off value of 8 points (an equivalent of 10 points with the full version of the Q-OSAS).Conclusion: The Q-OSAS is an appropriate screening tool to facilitate the screening of subjects potentially at risk from moderate and severe OSAS. A modified two-step interpretation of the Q-OSAS in Slovakia yielded the best sensitivity, and in the future could promote evaluation of sleepiness in sleep and wake disorders other than OSAS for fitness to drive. [ABSTRACT FROM AUTHOR]

Cognitive and physical impairment can occur with dementia and reduce driving ability. In the United States, individual states have procedures to refer and evaluate drivers who may no longer be fit to drive. The license review process is not well understood for drivers with dementia. This study uses comprehensive data from the Iowa Department of Transportation to compare the referral process for drivers with and without dementia from January 2014 through November 2019. The likelihood of failing an evaluation test was compared between drivers with and without dementia using logistic regression. The risk of motor-vehicle crash after referral for review of driving ability was compared using a Cox proportional hazard model. Analysis controlled for the age and sex of the referred driver. Drivers with dementia performed worse on all tests evaluated except the visual screening test. After the referral process, the risk of crash was similar between those with and without dementia. Drivers with dementia were denied their license more frequently than referred drivers without dementia. However, drivers with dementia who successfully kept their license as a result of the license review process were not at an increased risk of crash compared to other referred drivers.

This study aimed to evaluate the impact of traffic noise along the motorway on sleep quality, sleepiness, and vigilant attention in long-haul truck drivers. This was a randomized, crossover, within-subject controlled study. Healthy long-haul truck drivers spent 6 consecutive nights in a real truck berth with full sleep laboratory equipment. During 3 nights, subjects were exposed to replayed traffic noise alongside motorways, whereas the other 3 nights were without traffic noise. Polysomnography was recorded during the nights and numerous sleepiness tests and vigilance examinations were performed during the following standardized working day. Outcome measures were compared between noisy and silent nights using the paired Wilcoxon test. Ten healthy long-haul truck drivers with a mean age of 36.3 ± 7.3 years completed the study as planned. On noisy nights, subjects had greater latencies to the rapid eye movement (REM) phase (90 ± 32 min vs 69 ± 16 min, P = 0.074) and higher percentages of sleep stage 1 (13.7 ± 5.5% vs 11.2 ± 4.4%; P = 0.059). Subjects also rated their sleep quality as having been better during nights without noise (28.1 ± 3.7 vs 30.3 ± 6.2, P = 0.092). The impact of these differences on daytime sleepiness and vigilance was rather low; however, mean Karolinska Sleepiness Scale (KSS) scores measured during the course of the following day were higher on six out of eight occasions after noisy nights. The effects of overnight traffic noise on sleep quality are detectable but unlikely to have any major impact on the vigilant attention and driving performance of long haul-truck drivers with low nocturnal noise sensitivity. This might not be true for subgroups prone to sleeping disorders.

Post-concussion driving restrictions are eminent, but we lack understanding of current behaviors and opinions about driving following concussion among populations at risk of concussion. We aimed to describe post-concussion driving behaviors and opinions among collegiate student-athletes. Student-athletes completed a survey (response rate = 45.3%, 223/492) regarding their post-concussion driving behaviors and opinions. Response frequencies and percentages are presented. Student-athletes self-reported a total of 169 lifetime concussions (0.76 ± 1.02 each). Of the 169 concussions, 52.1% (88/169) were diagnosed and 52.7% (89/169) occurred while the student-athlete possessed a valid driver's license. Student-athletes refrained from driving following 43.8% (39/89) of the concussive events. Student-athletes who refrained most commonly did so for only 24–48 h (20.5%, 8/39) and because a health care provider advised them to (33.3%, 13/39). Student-athletes most commonly reported that they would feel "very unsafe" driving a car immediately following injury (38.4%, 84/219). When asked whether driving restrictions would influence their decision to report the injury to a health care provider, 7.9% reported that it "definitely would" (17/214), 26.6% "probably would" (57/214), 17.8%"neutral" (38/214), 24.8% "probably would not" (53/214), and 22.9% "definitely would not" (49/214). Despite generally believing that driving immediately following a concussion is unsafe, a majority of student-athletes did not refrain from driving at any point following their previous concussions. Post-concussion driving restrictions may have some influence on student-athletes' decisions to report the injury to a health care provider. Health care providers play a critical role in post-concussion driving restriction, but lack standardized recommendations to guide their care. [ABSTRACT FROM AUTHOR]

After memory impairment, one of the most common troubles of early Alzheimer's disease (AD) is the impairment of executive functioning. However, it can have major consequences on daily life, notably on the driving activity. The present study focused on one important executive function involved in driving: mental flexibility; and considered how this impairment can affect driving. Ten patients with early AD were matched with 29 healthy older drivers. All participants were given an evaluation of mental flexibility through neuropsychological tests and an experimental test developed on a static driving simulator. The experiment was divided in two conditions; one without mental flexibility and another condition with a mental flexibility demand. AD patients showed impairments in the neuropsychological tests evaluating mental flexibility. These deficits are linked to the deficits they showed in the driving simulator flexibility tests. This study contributes to the understanding of mental flexibility mechanisms and on their role in driving activity. It also confirms that the driving simulator is a suitable tool to explore cognitive disorders and driving ability.