Parkinson's Disease and Driving fitness: A systematic review of the existing guidelines

Background

Motor/ non‐motor symptomatology and antiparkinsonian drugs deteriorate driving ability of Parkinson's Disease (PD) patients. 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 on this procedure remain obscure.

Methods

We systematically reviewed the existing guidelines, regarding driving fitness evaluation of PD patients. The search was applied to MEDLINE and GoogleScholar identifying 109 articles. After applying specified inclusion criteria, 15 articles were included (9 National Guidelines, 5 Recommendation Papers, 1 Consensus Statement).

Results

The treating physician is proposed as the initial evaluator in 8/15 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 8 articles (cut‐off values in 4), while specific neuropsychological and visual tests are proposed in 7 articles each (cut‐off values in 4 and 3 articles, respectively). Conditional licenses are proposed in 11/15 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, sleep assessment and medication review are key components. Clear‐cut instructions regarding motor, neuropsychological, visual tests and relative cut‐off values are lacking. Conditional licenses and periodical re‐evaluation of driving fitness are important safety measures.

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