Validity of driving simulator in assessing drivers with Parkinson’s Disease

Background and objective: Clinical symptoms of Parkinson Disease (PD) can make driving hazardous. This paper aims to explore the validity of using driving simulator technology in assessing drivers with PD and highlighting the possibility of using such technology clinically to improve assessment and on-road safety of such population. Method: Fifty three idiopathic PD and 129 age matched controls were assessed by driver trained occupational therapist and driving instructor in open roads and the STISIM driving simulator. Prior to the driving assessments, PD participants were screened medically by a geriatrician. Scores from specific driving tasks were aggregated to a composite score representing overall driving performance of participants. Multivariate analysis was employed to explore the effects of independent variables of driving tasks. Results: The driving performance of the participants was confirmed to be negatively associated with age (r between 0.79 to 0.89, p<0.001). Drivers with PD were significantly less competent drivers than controls, as reflected by lower simulated driving performance scores (t180 = 104.6; p<0.001) and lower on-road scores (t180 = 84.2; p<000.1). The most committed errors on the road were failing to check the blind spot appropriately, signalling inappropriately to exit roundabouts, and reduced usage of rear view and side mirrors. After adjustment for age and gender, 39.1% of the variability of the on-road performance can be explained by the simulated driving performance in the PD group (F (4, 48) = 26.2, p-value < 0.001, R2 = 0.391), whereas in control group, 68% was explained (F (3, 125) = 82.75, p-value < 0.001, R2 = 0.675). Conclusion: The study concluded that PD drivers are significantly less competent drivers than the age matched control group. The driving simulator reflected less true driving performance in the PD group than in a normal older adult population. In a disease group, the lower reflection is not surprising. The simulator technology has the potential to be used in screening of unsafe PD drivers.