Driving restrictions post-stroke: Physicians' compliance with regulations.

OBJECTIVE: Suffering a stroke might lead to permanent cognitive and/or physical impairment. It has been shown that these impairments could have an impact on an individual's fitness to drive. In Sweden, as in many other countries, there are regulations on driving cessation post-stroke. Information on driving cessation should be given to all patients and noted in the journal. The present study sought to determine physician's compliance to driving regulations post-stroke as well as follow-up and gender aspects. METHOD: A retrospective study of medical records on stroke patients was carried out. The study covered all of the medical records on stroke incidents (n = 342) during a year at a typical medium to large-sized hospital in Sweden. RESULTS: A journal entry on driving cessation post-stroke was missing in 81% of the medical records. Only 2% of the patients were scheduled for a follow-up meeting specifically concerning fitness to drive. Significantly more men than women had an entry on driving in the journal. CONCLUSIONS: We conclude that the Swedish regulations on driving cessation post-stroke were not followed at the participating hospital. It is crucial that all stroke patients receive information on driving cessation because their condition might affect fitness to drive. Analysis of follow-up records showed that there was no consistent method for assessment of a patient's fitness to drive. There was also a gender difference in the material, which warrants further investigation.

Landscape heritage objects' effect on driving: a combined driving simulator and questionnaire study.

According to the literature, landscape (panoramas, heritage objects e.g. landmarks) affects people in various ways. Data are primarily developed by asking people (interviews, photo sessions, focus groups) about their preferences, but to a lesser degree by measuring how the body reacts to such objects. Personal experience while driving a car through a landscape is even more rare. In this paper we study how different types of objects in the landscape affect drivers during their drive. A high-fidelity moving-base driving simulator was used to measure choice of speed and lateral position in combination with stress (heart rate measure) and eye tracking. The data were supplemented with questionnaires. Eighteen test drivers (8 men and 10 women) with a mean age of 37 were recruited. The test drivers were exposed to different new and old types of landscape objects such as 19th century church, wind turbine, 17th century milestone and bus stop, placed at different distances from the road driven. The findings are in some respect contradictory, but it was concluded that that 33% of the test drivers felt stressed during the drive. All test drivers said that they had felt calm at times during the drive but the reason for this was only to a minor degree connected with old and modern objects. The open landscape was experienced as conducive to acceleration. Most objects were, to a small degree, experienced (subjective data) as having a speed-reducing effect, much in line with the simulator data (objective data). Objects close to the road affected the drivers' choice of' lateral position. No significant differences could be observed concerning the test drivers' gaze between old or modern objects, but a significant difference was observed between the test drivers' gaze between road stretches with faraway objects and stretches without objects. No meaningful, significant differences were found for the drivers' stress levels as measured by heart rate.

Crash barriers and driver behavior: a simulator study.

OBJECTIVE: The study examines how drivers experience a conventional W-beam guardrail (metal crash barrier) along both sides of narrow versus wider roads (single carriageway with 2 lanes) in terms of stress, feelings, and driving patterns and whether subjective experience concurs with the actual driving patterns captured by the quantitative data. METHODS: The study used different methods to capture data, including the VTI Driving Simulator III (speed and lateral vehicle position) in conjunction with electrocardiogram (ECG) data on heart rate variability (HRV) and questionnaires (oral during driving and written after driving). Eighteen participants--8 men and 10 women--were recruited for the simulator study and the simulator road section was 10 km long. RESULTS: Driving speeds increased slightly on the wider road and on the road with a crash barrier, and the lateral driving position was nearer to the road center on the narrower road and on the road with a crash barrier. The HRV data did not indicate that participants experienced greater stress due to road width or due to the presence of a crash barrier. Participant experience captured in the oral questionnaires suggested that road width did not affect driver stress or driving patterns; however, the written questionnaire results supported the simulator data, indicating that a wider road led to increased speed. None of the participants felt that crash barriers made them feel calmer. CONCLUSIONS: We believe that there is a possibility that the increased speed on roads with crash barriers may be explained by drivers' sense of increased security. This study demonstrates that an experimental design including experience-based data captured using both a simulator and questionnaires is productive. It also demonstrates that driving simulators can be used to study road features such as crash barriers. It seems more than likely that features such as street lamps, signs, and landscape objects could be tested in this way.

Aspects of awareness in patients with Alzheimer's disease.

BACKGROUND: The purpose of the present study was to gain insight into Alzheimer's disease (AD) patients' perception of the world through the study of a few aspects of awareness. The aspects in focus of the study were disease awareness, metacognition, managing of everyday life, and as a complement, the agreement (calibration) between patients and their spouses on the studied aspects was considered. METHOD: A mixed-method evaluation design was used involving 15 AD patients, their spouses, and 15 elderly healthy control subjects. The study comprised both a semistructured interview (AD patients and spouse) and a neuropsychological assessment (AD patients and control subjects). RESULTS: The patients were aware of their disease and able to report on their illness. Despite this awareness, they were unable to realize and manage the practical and cognitive implications of their impairment. The results also indicate that patients and spouses were not well calibrated regarding thoughts about the disease and problems in handling the cognitive deterioration. CONCLUSIONS: The findings of our study have relevance to patients' well being and how they manage everyday life. An open dialogue on these issues between spouses and in the care for AD patients would hopefully enhance quality of life for all parties involved.

A longitudinal study of semantic memory impairment in patients with Alzheimer's disease.

INTRODUCTION: The present study explored the nature of the semantic deterioration normally displayed in the course of Alzheimer's disease (AD). The aim was to disentangle the extent to which semantic memory problems in patients with AD are best characterized as loss of semantic knowledge rather than difficulties in accessing semantic knowledge. METHOD: A longitudinal approach was applied. The same semantic tests as well as same items were used across three test occasions a year apart. Twelve Alzheimer patients and 20 matched control subjects, out of a total of 25 cases in each group, remained at the final test occasion. RESULTS AND CONCLUSIONS: Alzheimer patients were impaired in all the semantic tasks as compared to the matched comparison group. A progressing deterioration was evident during the study period. Our findings suggest that semantic impairment is mainly due to loss of information rather than problems in accessing semantic information.

Weak central coherence in patients with Alzheimer's disease(•).

Central coherence refers to the ability to interpret details of information into a whole. To date, the concept of central coherence is mainly used in research of autism, Asperger's syndrome and recently in the research on eating disorders. The main purpose of the present study was to examine central coherence in patients with Alzheimer's disease. Nine Alzheimer's disease patients and ten age- and gender-matched control subjects, who differed significantly in neurological assessment, were shown a picture of a fire. Compared to control subjects, the Alzheimer's disease patients described the picture in a fragmented way by mentioning details and separate objects without perceiving the context of the fire. In conclusion, patients with Alzheimer's disease are at the weak end of central coherence, and hence suffer from a fragmented view of their surroundings. The findings have important clinical implications for the understanding of patients with Alzheimer's diseaseand also for the possibility of caregivers to meet the Alzheimer's disease individual in an appropriate way in the everyday care.