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This St. Petersburg Times (http://www.sptimes.com) story has been sent to you from [log in to unmask] ------------------------------------------------------------------------------------------- http://www.sptimes.com/2002/12/10/State/Study__Parkinson_s_ca.shtml Study: Parkinson's can impair driving By WES ALLISON, Times Staff Writer © St. Petersburg Times, published December 10, 2002 TAMPA -- A new study by researchers in Tampa found that Parkinson's patients are much more likely to be involved in car accidents, especially as the disease progresses. In an article published today in the journal Neurology, the study recommends establishing guidelines for when patients should surrender their licenses, a notion gaining popularity among some advocates and researchers, but one most states have not addressed. "We shouldn't be afraid to say that we need to monitor a patient's driving ability when they advance in disease," said Dr. Theresa A. Zesiewicz, associate professor of neurology at the University of South Florida and the study's lead author. "We're not talking about restricting patients on a global scale," she said. "What we're talking about is there needs to be dialogue, that physicians need to be aware that there is a potential problem. ... And as (patients) advance in disease, their driving ability ... needs to be carefully monitored." About 4-million Americans have Parkinson's disease, including about 55,000 in Florida. Although the study focused on Parkinson's, experts say it raises issues germane to a variety of diseases affecting mind and body. All states have special licensing requirements for people who suffer seizures, as from epilepsy, but most don't address progressive neurological diseases such as Alzheimer's or Parkinson's. Whether people keep driving is usually left to them. Their family or doctor may influence them, but Dr. Abraham Lieberman, medical director of the National Parkinson's Foundation, said it's often hard to tell if someone should be driving. Lieberman recommends people with Parkinson's -- or any neurologic disease -- go to a driver's license office, explain their condition and ask for a road test. They should retake the test periodically, he added. "This study is an important study because it raises the issues, particularly in a state like Florida where you have a large number of elderly people and a lot of people with Parkinson's disease," said Lieberman, a neurology professor at the University of Miami. "When you first get the disease, you're doing okay. But three or four years into the disease you're doing terribly, and there's no provision for someone to say 'Okay, you've had Parkinson's, come and see me."' The USF researchers enrolled 39 volunteers with Parkinson's and 25 without any neurologic disease. Both groups had a median age of about 65. After practicing for about 15 minutes, they were tested on a driving simulator. The test counted only the accidents that the computer considered fatal. Although Zesiewicz said she expected the Parkinson's patients to crash more, she was shocked by the magnitude: Among those with the earliest stage of Parkinson's -- Stage 1 on a 5-stage scale -- 20 percent were involved in an accident, versus just a fraction of study participants without the disease. 56 percent of Stage 2 patients crashed. And 90 percent of Stage 3 Parkinson's patients crashed. All of the Stage 4 patients crashed, and Stage 5 patients generally are considered unable to drive. Only a few of the non-Parkinson's patients crashed. Zesiewicz, assistant director of the Parkinson's Disease and Movement Disorders Clinic at USF, said the problems stemmed from both mental and physical declines. Parkinson's causes cognitive lapses in about one-third of patients, and frequently causes tremors, stiffness or slowness of movement. Janet Reno, former U.S. attorney general and Florida's best-known Parkinson's patient, drove her red truck more than 30,000 miles during her unsuccessful campaign for governor this year. Both of her arms shake noticeably, but Reno says she has always asked friends and family to tell her if she becomes wobbly behind the wheel. "All of us, whether it's because of Parkinson's or something else, have got to take steps to ensure that they're competent to drive," said Reno, who has Stage 2 Parkinson's. "I think all of driving relies on one's good judgment." Neurology is one of the nation's most respected medical journals, and today's publication will likely aid Zesiewicz's efforts to win more funding for further study. But some aspects of the findings are bound to be disputed. Some researchers question the accuracy of driving simulators, and suggest people drive better on the road, when they know it counts. Increasing restrictions on older drivers also has traditionally been met with resistance in Florida, where little public transportation is available. But Dr. Janan Smither, associate professor of psychology at the University of Central Florida and head of the research subcommittee of the Florida At-risk Driver Council, said focusing on specific diseases and driving, rather than age, may ease the resistance. In Florida, anyone can anonymously report an unfit driver to the Department of Highway Safety and Motor Vehicles, and the state can require drivers to submit a medical report or undergo an examination. Otherwise, Floridians may renew their license three times -- up to 18 years -- via phone, mail or the Internet, without passing so much as an eye exam. Some states, such as Illinios, require drivers over 70 or 75 to pass a road test when they renew licenses, but most have few restrictions. What's lacking, experts say, is a quick and reliable test that seniors can take at a community center or doctor's office to see if they need additional testing. Disease stages Progressive stages of Parkinson's disease, based on the Hoen and Yahr scale. Drugs often help patients stay at Stage 2 or Stage 3. Few reach Stage 5. Stage 1: Tremors or rigidity affecting one side of the body. Stage 2: Tremors or rigidity affecting both sides of the body. Stage 3: Stage 2, plus postural instability, or awkwardness of gait. Stage 4: Stage 3, plus need for routine assistance. Stage 5: Must use wheelchair. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn