Highlights
- •Identifying impaired driving capacity in ALS is difficult.
- •No difference in simulated driving task was observed despite mild to moderate functional and cognitive decline.
- •Results do not imply these are “safe” drivers.
- •Cost-effective and reliable clinical assessments, to determine medical fitness to drive in individuals with ALS are needed.
Abstract
Objective
Compare driving capacity of individuals with Amyotrophic Lateral Sclerosis (ALS) and
healthy controls (HC) using a driving simulation program.
Methods
A prospective study was performed on individuals with ALS who reported they were still
driving, and a group of HCs. Demographic data included age and gender. Assessment
included cognitive assessments (Montreal cognitive assessment [MoCA] and ALS Cognitive
Behavioral Scale [ALS-CBS]); gait speed (m/s); ALS Functional Rating Scale-revised
total score (ALSFRS-R); and simulated driving assessment (Lane Change Task [LCT]).
The LCT is a simple assessment tool which simulates the visual, cognitive, and motor
demands of driving to detect at-risk drivers and uses distractions (secondary tasks)
to quantify the performance loss on the primary task (lane changes).
Results
Twenty-eight individuals with ALS (22 males, mean age 64 years) and 20 HCs (7 males,
mean age 59 years) were studied. Individuals with mild to moderate ALS (ALSFRS-R mean
36.2) were older, had mild cognitive difficulty (MoCA 24 vs 27; ALS-CBS 14.19 [SD
3.85]) and mobility decline (gait speed 1.1 vs 1.4 m/s) compared to HC. Driving assessment
using the LCT found no differences in baseline scores or during motor, cognitive,
or visually distracting conditions.
Conclusions
Individuals with ALS with mild to moderate disease progression, with cognitive and
motor weakness still demonstrate similar driving capacity to HCs using a driving simulation
task. Driving assessment needs to be expanded longitudinally and perhaps with more
robust measures to more precisely identify types of driving challenges that lead to
cessation of driving in individuals with ALS.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Amyotrophic lateral sclerosis: moving towards a new classification system.Lancet Neurol. 2016; 15: 1182-1194
- Detecting frontotemporal dysfunction in ALS: utility of the ALS cognitive Behavioral screen (ALS-CBS).Amyotroph. Lateral Scler. 2010; 11: 303-311
- Functional changes and driving performance in older drivers: assessment and interventions.Geriatrics. 2016; 1: 12
- Mild dementia and driving ability. Part 2: assessment and its consequences in practice.Z. Gerontol. Geriatr. 2014; 47 (quiz 354-345): 345-353
- ALS-specific cognitive and behavior changes associated with advancing disease stage in ALS.Neurology. 2018; 91: e1370-e1380
- Research brief: a literature review of frontotemporal dementia and driving.Am. J. Alzheimers Dis. Other Dement. 2014; 29: 404-408
- Cognitive problems, self-rated changes in driving skills, driving-related discomfort and self-regulation of driving in old drivers.Accid. Anal. Prev. 2012; 49: 322-329
- Longitudinal executive changes in drivers with Parkinson’s disease: study using neuropsychological and driving simulator tasks.Eur. Neurol. 2016; 76: 143-150
- Implications of vision testing for older driver licensing.Traffic Inj. Prev. 2008; 9: 304-313
- World Federation of Neurology Research Group on motor neuron D. El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis.Amyotroph Lateral Scler Other Motor Neuron Disord. 2000; 1: 293-299
- The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS study group (phase III).J. Neurol. Sci. 1999; 169: 13-21
- The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.J. Am. Geriatr. Soc. 2005; 53: 695-699
- The Montreal cognitive assessment: validity and utility in a memory clinic setting.Can. J. Psychiatr. 2007; 52: 329-332
- Behavioral and affective features of amyotrophic lateral sclerosis patients.J. Neurol. Sci. 2017; 381: 119-125
- Association between Montreal cognitive assessment sub-item scores and corresponding cognitive test performance in patients with frontotemporal dementia and related disorders.Dement. Geriatr. Cogn. Disord. 2017; 43: 170-179
- Cognitive-behavioral screening reveals prevalent impairment in a large multicenter ALS cohort.Neurology. 2016; 86: 813-820https://doi.org/10.1212/WNL.0000000000002305
- A self report measure of affective lability.J. Neurol. Neurosurg. Psychiatry. 1997; 63: 89-93
- Pseudobulbar affect as a negative prognostic indicator in amyotrophic lateral sclerosis.Acta Neurol. Scand. 2018; 138: 55-61
- Walking speed: the functional vital sign.J. Aging Phys. Act. 2015; 23: 314-322
- Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment.Arch. Phys. Med. Rehabil. 2001; 82: 9-13
- Excellent inter-rater, intra-rater, and telephone-administered reliability of the ALSFRS-R in a multicenter clinical trial.Amyotroph. Lateral Scler. 2007; 8: 42-46
- Measuring distraction: task duration and the lane-change test (LCT).Proce. Hum. Fact. Ergon. Soci. Ann. Meet. 2005; 49: 1980-1983
- The Lane Change Task as a Tool for Driver Distraction Evaluation.Ergonomia Verlag, Stuttgart2003
- Surrogate Distraction Measurement Techniques: The Lane Change Test.CRC Press, 2009
- Learning effects in the lane change task (LCT)--realistic secondary tasks and transfer of learning.Appl. Ergon. 2014; 45: 639-646
- Classification of walking handicap in the stroke population.Stroke. 1995; 26: 982-989
- Visual and cognitive distraction metrics in the age of the smart phone: a basic review.Ann. Adv. Automot. Med. 2014; 58: 15-23
- Fluctuating attentional demand in a simulated driving assessment: the roles of age and driving complexity.Traffic Inj. Prev. 2011; 12: 576-587
- Clinician's Guide to Assessing and Counseling Older Drivers. 3rd ed. American Geriatrics Society, 2015
- Utility of the MOCA as a cognitive predictor for fitness to drive.J. Neurol. Neurosurg. Psychiatry. 2016; 87: 567-568
- Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting.J. Am. Geriatr. Soc. 2013; 61: 1164-1169
Article info
Publication history
Published online: February 19, 2020
Accepted:
February 15,
2020
Received in revised form:
January 23,
2020
Received:
November 27,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
