Is the Sleepy Parkinson's Patient Able to Drive Safely?
Abstract & Commentary
By Charles P. Pollak, MD, Professor, Clinical Neurology, Weill College of Medicine. Dr. Pollak is a stockholder for Merck, and is on the speaker's bureau for Merck.
Synopsis: Parkinson's patients with daytime sleepiness should drive with a companion.
Source: Amick MM, et al. Excessive daytime sleepiness and on-road driving performance in patients with Parkinson's disease. J Neurol Sci. 2007;252:13-15.
Patients with Parkinson's Disease (PD) are vulnerable to a variety of sleep disorders and often have excessive daytime sleepiness (EDS), especially if they are treated with dopamine agonists (DAs) such as pramipexole or ropinirole. It has been suggested that "attacks" of sleepiness may occur without warning in such patients, putting themselves and others at risk. The present investigation was undertaken to assess the ability of patients with PD to drive safely, using a standardized on-road evaluation.
Twenty-one men and women with PD who were not demented and had valid drivers' licenses were administered a standardized road test by a professional driving instructor. Of the 21subjects, 14 received a "safe" driving evaluation, whereas 7 were considered "marginal." Ratings were not explained by differences in EDS (which affected 5 subjects). Thirteen subjects were treated with a dopamine agonist (DA — pramipexole, ropinirole or pergolide). Those so treated had higher self-ratings of sleepiness (Epson sleepiness scale), but their road-test scores were not affected.
Commentary
This small, preliminary study confirms that sleepiness is indeed common in patients with PD, especially those treated with DAs. Although 7 of the 21 PD patients were rated as "marginal" rather than "safe" drivers, neither EDS nor use of DAs accounted for their driving performance. It is a pity that a larger sample was not studied, as it might well have demonstrated an adverse effect of EDS on driving performance; even a small effect may prove fatal on the highway. The authors correctly suggest that the presence of a driving instructor may have kept the PD subjects alert. Longer drives (the duration of the road test that was administered was not specified) or tests of motor performance done with a driving simulator might have revealed alarming effects of EDS or of DAs that the present results only hint at. The authors themselves felt obliged to recommend that PD patients with EDS drive with companions, presumably to prod them awake whenever necessary.
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