New Study to Test Driving Ability and Cognitive Skills in MS

Lisa Emrich Health Guide November 30, 2012
  • Do you drive?

    Sunday evening, Rob and I had dinner at his mother’s house with a few family friends.  We had such a lovely time that the clock seemed to speed up and before we knew it, it was 10:30PM and time to go home.  I was full of yawns and ready to lay my head on a soft pillow.

    My mother-in-law asked who was driving home and I answered with a pointed finger aimed in Rob’s direction.  Rob replied, “Ha, I guess I’m driving.”  Besides feeling tired, I knew that driving home in the dark on Sunday was not ideal.  Why?  Because my night vision is not what it once was and I’ve officially reached “that age” where vision changes are common.  At least that’s what my optometrist informed me a few years ago.


    Another reason I prefer to sit in the passenger’s seat at night is due to residual damage from a couple bouts of optic neuritis.  My contrast sensitivity vision is somewhat diminished and details are difficult to see in the dark.  Plus, we had taken Rob’s car anyways so it makes sense that he would drive.

    Did you know that the accident rate for drivers diagnosed with MS is higher than healthy persons of the same age?  About three times higher according to early research studies on the subject from Denmark (Lings, 2002) and New Jersey (Schultheis, 2002).

    Common MS symptoms which may affect driving include:

    • Sensory (touch) problems such as tingling or numbness in hands and feet
    • Visual problems such as blurred or double vision, changes in your visual field or contrast sensitivity, or a temporary loss of sight caused by optic neuritis (inflammation of the optic nerve)
    • Fatigue which can make MS symptoms worse
    • Loss of muscle strength, control and dexterity
    • Problems with walking, balance and coordination
    • Muscle spasms and stiffness (spasticity), or paralysis
    • Bladder and bowel problems
    • Difficulty with memory, concentration, and thinking.

    Do you experience any of these symptoms?  I know that I do on occasion.  The only time I absolutely did not drive for an extended period of time was due to optic neuritis.  In 2000, I was performing with Baltimore opera and found a colleague with whom to ride to/from rehearsals and performances.

    How do you know if you should or shouldn’t be driving?

    Research has found that information processing and visuospatial skills are predictive of driving performance among persons with MS. Cognitive tests, specifically the Symbol Digit Modalities Test (SDMT) and the Spatial Recall Test (SPART 7/24), may be useful as screening methods for identifying the potential impact of cognitive impairment on driving (Schultheis, 2010).

    However, Dr. Akinwuntan, a professor at Georgia Health Sciences University, says that the current practice is to administer 15 to 22 different tests that can last up to three hours and cost as much as $450 to patients with MS who need to be evaluated for driving appropriateness.

    In a recent study, Akinwuntan’s team at GHSU assessed 44 patients with relapsing-remitting MS and EDSS scores ranging from 1 to 7 to determine which off-road cognitive tests could predict a patient’s pass or fail performance on a road test.  Out of a large battery of tests (which more than 30 components) taken by this group of MS patients, five were found to predict driving ability with 91% accuracy and can be given in less than 45 minutes at a cost of approximately $150 (Akinwuntan, 2012).


  • Akinwuntan has received a $360,000 grant from the National Multiple Sclerosis Society to conduct a larger study to verify these results.  The new study will include 180 patients with all four types of MS and narrow participation to those with EDSS between 3 and 7 which are ”those people in the middle who are starting to experience deficits that would affect their driving,” according to Akinwuntan. 

    Recruitment is underway for 90 participants at the GHSU Multiple Sclerosis Clinic in Augusta and an equal number at the Andrew C. Carlos MS Institute at the Shepherd Center in Atlanta.

     

    SOURCES:

    Driving with Multiple Sclerosis: Can I? Should I?” by David Orange, NARCOMS Staff Writer with contributions from John Brockington, MD, Associate Professor and Director, Division of General Neurology at the University of Alabama at Birmingham. Accessed November 26, 2012.

    Driving with Multiple Sclerosis.” John Vaughter, certified driver rehabilitation specialist.  Accessed November 26, 2012.

    Motoring with Multiple Sclerosis.”  MS Society UK.  Accessed November 26, 2012.

    Akinwuntan AE, Devos H, et al. Predictors of driving in individuals with relapsing-remitting multiple sclerosis. Mult Scler 2012 Jul 3.  [Epub ahead of print]  doi: 10.1177/1352458512451944 

    Lincoln NB, Radford KA. Cognitive abilities as predictors of safety to drive in people with multiple sclerosis. Mult Scler 2008;14;123-128. Originally published online Sep 24, 2007; DOI: 10.1177/1352458507080467

    Lings S. Driving accident frequency increased in patients with multiple sclerosis. Acta Neurol Scand 2002; 105: 169–173.

    Schultheis MT, Weisser V, et al. Examining the Relationship Between Cognition and Driving Performance in Multiple SclerosisArch Phys Med Rehab 2010;91(3):465-473.

    Schultheis MT, Garay E, Millis SR, et al. Motor vehicle crashes and violations among drivers with multiple sclerosis. Arch Phys Med Rehab 2002;83:1175–1178.  

     

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.