Friday, March 1, 2024

Parkinson’s Disease And Driving

How To Ease The Transition

My Parkinson’s Story: Driving

Frank discussions with family members and doctors are often enough to convince people with Parkinsonâs disease to modify their driving. Some people may need additional input from a support group, lawyer, or financial planner to ease the transition.

Some people with Parkinson’s disease can continue driving under strict guidelines, although the long-term goal will still be to eventually stop driving. Guidelines for limited driving may include:

  • Drive only on familiar roads
  • Limit drives to short trips
  • Avoid rush-hour traffic and heavily traveled roads
  • Restrict drives to daylight hours during good weather

Itâs important for family and friends to find ways to help their loved one reduce their need to drive. These include arranging for groceries, meals, and prescriptions to be delivered to the home, or for barbers or hairdressers to come to the home.

Itâs also important to help your loved one become accustomed to using alternate methods of transportation, such as:

  • Rides from family and friends
  • Taxi cabs
  • Public buses, trains, and subways
  • Walking

Your local Area Agency on Aging can help you find transportation services for a loved one. Eldercare Locator, a service of the U.S. Administration on Aging, can also assist. Its phone number is 800-677-1116,

If your loved one refuses to voluntarily limit or stop driving, despite a demonstrated need to do so, you may need to take more aggressive steps, such as:

  • Hiding the car keys

Ways To Monitor Driving Skills Of Parkinsons Disease Patients

Even if any independent evaluation highlights a patient may drive safely, it is essential to continue with monitoring the driving skills for detection of problems, which may result in any severe accident. For this, one should check key warning signs-

  • Driving extremely slowly
  • Stopping in huge traffic without any reason
  • Ignoring traffic signals
  • Getting lost while driving on a familiar route
  • Difficulty in executing turns and changes of lanes
  • Drifting to other traffic lanes or driving on the wrong side in street
  • Forgetting to give signals or signal in an incorrect way
  • Ignoring other vehicles, road hazards and pedestrians
  • Parking in a no parking area or in an incorrect manner
  • Feeling drowsiness or sleepy behind their wheels
  • Frequently getting tickets or penalties for violating traffic rules
  • Involving in nearby miss situations, accidents and fender benders.

Any of these signs may indicate the time to stop driving cars for parkinsons disease patients. It is very much essential to discuss the concerns with patients and their doctors.

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Who Determines Fitness To Drive In Parkinsons Disease Patients

Fitness to drive protocols vary greatly from country to country. While no uniform international standard exists, medical standards for driver licensing and physicians guidelines for assessment of fitness to drive have been established in some countries, including the United States , Canada , United Kingdom , and Australia . Roles and responsibilities of drivers, health professionals, and driver licensing authorities have been proposed. While drivers have a responsibility to self-assess driving abilities and report any permanent injury or illness that may affect their ability to drive safely, health professionals have an ethical and legal duty to maintain patient confidentiality and must have legal justification for breaching that trust in cases where an unfit driver may pose a threat to public safety. Physicians that evaluate for fitness to drive and that identify a condition that may impair driving performance are obligated to report that finding to drivers licensing authorities . The driver licensing authority is then tasked with the responsibility of deciding whether to license a driver or not, based upon the drivers health report, driving performance record, and violation history.

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Parkinson’s Medication And Driving

Drowsiness can be a side effect of some Parkinsons medications, particularly dopamine agonists. In some cases, medications can cause you to suddenly fall asleep or feel excessively sleepy during the day.

Regulations regarding this vary, so it is important that you check with your countrys regulatory body to confirm their policy. If you experience drowsiness you should stop driving until you have spoken with your doctor. Changing medication can sometimes help, but not always.

How Can I Help Myself

Dexterity &  Driving

To accommodate life with Parkinsons you may need either to change the type of car you drive or to make adaptations to your existing vehicle. Investigate all available options and follow up those that are practical and will help overcome any difficulties, bearing in mind that symptoms are likely to progress. Examples include:

  • cars that are easier to drive and have been designed to suit people with disabilities
  • cars that provide more space so that you can manoeuvre yourself in and out more easily
  • power steering
  • an automatic gearbox
  • other automatic functions, e.g. electric windows and windscreen wipers that are activated when it rains
  • swivel seats or sitting on a sheet of plastic to make it easier to get in and out of your car seat
  • door handles that are simple to open
  • hand controls or aids to make steering, braking or acceleration.

Always take a mobile phone with you when you drive, so you can call for assistance if you get into difficulties or have an accident.

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About The Michael J Fox Foundation For Parkinsons Research

As the worlds largest nonprofit funder of Parkinsons research, The Michael J. Fox Foundation is dedicated to accelerating a cure for Parkinsons disease and improved therapies for those living with the condition today. The Foundation pursues its goals through an aggressively funded, highly targeted research program coupled with active global engagement of scientists, Parkinsons patients, business leaders, clinical trial participants, donors and volunteers.

Patient Disease And Driving Characteristics

The patients disease and driving characteristics are summarised in . The mean age was 70 years old and the majority of subjects were male . Most had been referred for assessment by the DVLA , held a full license and drove a manual transmission vehicle . Most participants were only driving in the local area and had been driving in the last 6 days . Equal proportions were driving less than and more than weekly.

Table 1

Patient, disease, driving characteristics and univariable logistic regression ). Data are n , mean , median . OR =odds ratio, CI =95% confidence interval, P =P-value, DVLA =Driver and Vehicle Licensing Agency, GP =General practitioner, Section 88 =Section 88 of Road Traffic Act 1988, PD =Parkinsons disease, RDB =Rookwood Driving Battery.

Predictor variable .

The median disease duration was 7 years . The RDB was the predominant cognitive test used . The average RDB score was 6 . The majority of subjects did not demonstrate a depth of vision nor visual field deficit . The median lowest contrast sensitivity seen was 20% and 71% of subjects passed the glare recovery test. Median response time was 0.60 seconds . The assessment outcome was mostly negative with 63% of participants given a not drive outcome.

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Legal Obligations Insurance And Tax

Your legal obligations will depend on the laws of the country in which you live. In many countries, your doctor will be obliged to carry out a regular ‘fit to drive’ check.

The most common heath-related driving laws in European countries are outlined below but you should always check on current legislation with your doctor or a suitably qualified member of your healthcare team.

  • Notify your national driver and vehicle licensing body that you have Parkinsons: they will advise you of the steps you need to take to retain your driving licence. This may involve contacting your doctor to confirm your fitness to drive, a medical examination or a driving test. Some countries may issue a licence for a fixed term, usually renewable provided your ability hasnt deteriorated sufficiently to make you unfit to drive.
  • Inform your insurance company: you should tell the company of any health change that may affect your driving. In most countries it is an offence to make a false statement or withhold information for the purposes of obtaining a certificate of motor insurance. Anyone who drives when considered unfit will invalidate their insurance cover.
  • Do I Have To Inform My Car Insurance Of My Diagnosis

    Considerations for Driving with Parkinson’s Disease

    You must inform your car insurance of your Parkinsons disease diagnosis. Let them know what information your doctor gave you to help them determine the best coverage for your specific situation. Failure to inform your insurance company of your diagnosis could invalidate your insurance policy.You also need to inform your insurer if any adaptations are made to your vehicle. Contact your car insurance provider to find out how to proceed. You can also shop around for insurance to compare coverage and prices.

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    How Can I Talk To A Loved One About The Progression Of Their Driving

    The ability to drive is an important component of self-esteem and independence for many.

    Your loved one may therefore get very emotional once approached about the progression of their driving. You can first acknowledge their good behaviours and then share your concerns without making them feel guilty.

    You and your loved one can determine a transitioning schedule together based on the appearance of warning signs indicating that they should stop driving.

    If your loved one shows resistance, talk about potential risks for them and others if they continue driving unsafely. Finally, talk about it with their care team to get help.

    With time, you may no longer be able to drive. You can use alternative means of transportation such as:

    • Taxi

    How Do I Know If I Can Drive Safely

    • Ask a trusted friend or family member for honest input about your driving skills.

    *Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both” to stay best informed on the Foundation’s work and the latest in PD news.

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    My Parkinson’s Story: Driving

    This 9-minute video alternates between an interview with a man and his wife and several specialists. The man and his wife share how he gave up his driver’s license due to Parkinson’s symptoms and how he is adjusting. The specialists share how Parkinson’s symptoms affect a person’s ability to drive, and how driving and cognitive assessments can determine a person’s fitness to drive.

    What Symptoms Of Pd May Interfere With The Ability To Drive Safely

    Parkinson

    Driving is a complex task that requires vision, appropriate motor skills, and higher levels of cognitive function to carry out safely. The most obvious symptoms that can impact driving ability for people with PD are typically motor difficulties such as resting tremors, rigid movements and difficulty maintaining stable posture, which may make it difficult to operate a vehicle safely. What is less obvious, and often more concerning, is that certain non-motor difficulties that can accompany PD may also interfere with driving. These include decreased contrast sensitivity which limits a persons ability to see things in the dark, decreased proprioception, which impairs a persons ability to know where their body is in space , decreased visual spatial skills, which may affect the ability to know how the car is positioned on the road, and difficulties with cognitive function which can impact memory, processing speed, attention, and problem solving. In our own day-to-day evaluations with drivers who have PD, we often find that it is the cognitive impairment that most impacts driving. Drowsiness that accompanies later stages of PD and medication side effects can also impact the ability to drive safely. Non-motor symptoms are less evident than motor symptoms and have been shown to be a more serious risk to driving safety in some people with PD.

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    Can You Drive A Car With Parkinsons Disease

    Parkinsons disease involves a specific type of movement disorder, which significantly impairs an individuals driving skills and cause his/her safety concerns. Even the problem forces a large number of people suffering from parkinsons disease problem to stop driving their cars. Because of this, primary symptoms present in Parkinsons disease interfere seriously with one of the complicated tasks i.e. driving a car. These symptoms include the following-

    • Tremor i.e. trembling in arms, hands, jaws, legs and head
    • Rigidity i.e. stiffness in both trunk and limbs
    • Slowness in body movements and
    • Impaired balance or postural instability.

    Along with this, a few people dealing with Parkinsons disease develops cognitive impairment, which includes defects in language, problem solving and language.

    Systematic Review Of Assessment Tools For Determining Fitness To Drive In Parkinsons Disease Patients

    The aim of this study was to perform a systematic review of the four main driving assessment methods and provide the evidence on individual methods for assessing driving ability in PD patients. To address the question of how much evidence we have regarding driving competency in PD, we performed a systematic review by searching MEDLINE, life science journals, Google scholar, and online books using the following key words: driving OR driving safety OR driving ability OR road test OR driving questionnaires OR sleepiness scale OR driving simulator OR naturalistic driving OR car sensor OR reaction time OR driver OR transportation OR automobile OR car OR vehicle OR collision injury OR car accident. Selected articles were required to have the term Parkinsons disease AND any one of the above key words within the title and/or abstract.

    Table 3 Summary of studies involving driving assessment tools in patients with Parkinsons disease

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    Pd May Affect Cognitive Skills For Driving

    People with PD may experience a . These skills are used when driving in complex environments, when conversing with a passenger, and when navigating to unfamiliar destinations. During navigation, drivers split their attention between driving or paying attention to changes in the environment and looking for navigational signs. A driver with PD may make driving errors while navigating.

    Driving A Vehicle Safely

    Driving with Parkinson’s Disease

    Being able to drive a vehicle requires high levels of skill and ability. A driver either needs to be unaffected by a medical condition, or have a medical condition that is controlled so that symptoms are highly unlikely to cause any problems.

    Sadly, Parkinsons is a progressive condition and deterioration is inevitable. Itll affect many activities, including driving. This is why it is so important that all drivers who are diagnosed with Parkinsons must tell DVLA. The rate of deterioration varies, but recognising that it will happen is important. It allows the patient and their family time to make plans for any lifestyle changes that may be necessary.

    Knowing you will eventually lose the ability to drive is never easy to accept. But it may be more bearable if the person has time to adjust and plan alternative ways of travel. For example: public transport, taxis, or lifts from friends and relatives.

    For professional drivers, who must demonstrate a greater level of fitness to drive, it may involve reviewing work options for the future.

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    Aim To Understand Disease

    Northwestern University scientists have received two awards totaling nearly $18 million for Parkinsons disease research from The ASAP Collaborative Research Network, a program of the Aligning Science Across Parkinsons initiative being implemented through The Michael J. Fox Foundation.

    The ASAP network supports multidisciplinary, multi-institutional research teams to address key knowledge gaps in the basic circuit mechanisms that contribute to the development and progression of Parkinsons disease.

    D. James Surmeier, PhD, the chair and Nathan Smith Davis Professor of Neuroscience, received a $9 million award over three years to study Distributed circuit dysfunction underlying motor and sleep deficits in a progressive mouse model of Parkinsons disease. Surmeier, the principal investigator, will collaborate with Ann Kennedy, PhD, assistant professor of Neuroscience from Northwestern Rui Costa, DVM, PhD, professor of Neuroscience and Neurology at Columbia University Yang Dan, PhD, professor of Neurobiology at University of California Berkeley Silvia Arber, PhD, at University of Basel and Jun Ding, PhD, associate professor of Neurosurgery and of Neurology at Stanford University.

    Advice On Driving With Parkinsons

    Surrendering your drivers license is like surrendering your independence but unfortunately that time must come at some point in your Parkinsons journey.

    It is important to remember that Parkinsons can affect your ability to self-evaluate. Therefore, it is a good starting point to discuss your driving with your caregivers and your doctor. They may have a different perception of your driving skills.

    In the early stages of Parkinsons, you have the option to modify your driving habits to address the physical and cognitive changes you are experiencing. For example, you can adapt by driving shorter distances and avoiding peak hour traffic and night- time driving. Or if you drive a manual car, it may be sensible to convert to an automatic instead.

    However, as your condition progresses, issues may develop which could result in impaired driving performance.

    Insurance Regulations

    It is recommended that you inform your insurance company of your Parkinsons diagnosis however it is not mandatory. In some cases, failure to disclose this information may result in your insurance being cancelled.

    Driving, Parkinsons and Medications

    Just as sight-impaired people must wear their glasses when driving, people living with Parkinsons must take their medication as prescribed when driving.

    Therefore, when starting to take a new medication, check with your doctor and pharmacist that it is safe to drive.

    Roads and Maritime Service Requirements

    Will your doctor notify the RMS?

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    Is It Ok To Limit Driving Instead Of Stopping Completely That Is Only Drive Locally Or During The Day

    What we find is that as we age, most people normally begin to restrict their driving. For example, older drivers often prefer to not drive at night, drive in familiar areas only, and limit highway and rush-hour driving. Drivers usually are more comfortable driving in familiar areas that are close to home and driving during the daytime. The more frequently we drive places, the more familiar we are with the streets, traffic patterns, and routes, making it easier for us to navigate. But even when driving locally, the unexpected situation can still occur . Therefore, restricting driving to a persons local area is not always sufficient. It really depends on both the type and level of severity of impairment that the person with PD is experiencing. Restricting driving is most useful when the type and severity of impairment will support the drivers ability to follow through safely with the restriction. Advice from a physician and/or occupational therapist who works with driving can be beneficial in guiding such a decision.

    An additional concern arises when drivers who need to restrict their driving fail to do so. Usually those who fail to restrict when necessary have cognitive impairments which limit their insight into the need for restrictions.

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