背景:运动/非运动症状学和抗帕金森病药物会降低帕金森病(PD)患者的驾驶能力。
目的:治疗神经科医生经常被要求评估患者的驾驶健康状况并提供循证咨询。尽管已经发布了一些指南,确切的过程以及神经科医生在这个过程中的作用仍然不清楚。
方法:我们系统地回顾了现有的指南,关于PD患者驾驶体能评估。我们搜索了MEDLINE和GoogleScholar,并确定了109篇文章。在应用了指定的纳入标准后,包括15篇文章(9条国家准则,五份推荐信,和一份共识声明)。
结果:在15篇文章中的8篇(2篇文章中的神经科医生)中,主治医师被建议作为初始评估者,并且可以推荐患者进行二线评估。评估应包括电机,认知,和视觉评估(在15、13和8条中提出,分别)。在八篇文章中提出了特定的运动测试(四篇中的截止值),而具体的神经心理学和视觉测试分别在七篇文章中提出(四篇和三篇文章中的截止值,分别)。在15条中的11条中提出了有条件的许可,方便PD患者驾驶。我们在PD患者驾驶适应性评估程序的图形上总结了我们的发现。
结论:大多数指南都认可PD患者驾驶适应性评估的神经系统方面。电机,神经心理学,视觉,睡眠评估和药物审查是关键组成部分。关于电机的清晰切割说明,神经心理学,缺乏视觉测试和相对临界值。有条件的执照和定期的驾驶适应性重新评估是重要的安全措施。
BACKGROUND: Motor/nonmotor symptomatology and antiparkinsonian drugs deteriorate the driving ability of Parkinson\'s disease (PD) patients.
OBJECTIVE: Treating neurologists are frequently asked to evaluate driving fitness of their patients and provide evidence-based consultation. Although several
guidelines have been published, the exact procedure along with the neurologist\'s role in this procedure remains obscure.
METHODS: We systematically reviewed the existing
guidelines, regarding driving fitness evaluation of PD patients. We searched MEDLINE and Google Scholar and identified 109 articles. After specified inclusion criteria were applied, 15 articles were included (nine national
guidelines, five recommendation papers, and one
consensus statement).
RESULTS: The treating physician is proposed as the initial evaluator in 8 of 15 articles (neurologist in 2 articles) and may refer patients for a second-line evaluation. The evaluation should include motor, cognitive, and visual assessment (proposed in 15, 13, and 8 articles, respectively). Specific motor tests are proposed in eight articles (cutoff values in four), whereas specific neuropsychological and visual tests are proposed in seven articles each (cutoff values in four and three articles, respectively). Conditional licenses are proposed in 11 of 15 articles, to facilitate driving for PD patients. We summarized our findings on a graphic of the procedure for driving fitness evaluation of PD patients.
CONCLUSIONS: Neurological aspects of driving fitness evaluation of PD patients are recognized in most of the
guidelines. Motor, neuropsychological, visual, and sleep assessment and medication review are key components. Clear-cut instructions regarding motor, neuropsychological, and visual tests and relative cutoff values are lacking. Conditional licenses and periodical reevaluation of driving fitness are important safety measures.