The Controversy Surrounding Driving with Parkinson's
You might think that the most controversial Parkinson’s disease-related topic involves politics like the stem cell controversy, sexual obsessions and compulsions from dopamine agonists, or a religious quandary (Why me, God?).
The most controversial issue is driving with Parkinson's disease. Writing about this emotionally charged topic feels like writing about end-stage Parkinson's disease–gut-wrenching and anxiety provoking.
Joseph Friedman, M.D. thinks the topic of driving with Parkinson's disease (PD) is so important that he devoted an entire chapter to it in his latest book Making the Connection between Brain and Behavior: Coping with Parkinson’s Disease.
Patients with PD may be unable to evaluate their own driving, while their neurologists may be overestimating their patients’ abilities to drive.
Driving involves a number of activities including perception, information processing, judgment, decision-making, coordinated limb movements, reaction time tasks, continuous tracking, and attention. PD causes a number of abnormalities in these areas.
Research on drivers with PD revealed a number of problems we all need to consider as we work to keep our abilities sharp.
Reduced physical and mental reaction time is due to bradykinesia (slowness of movement). PD patients are slow performing most tasks, and may react to emergency situations with more delay than people without PD. It may be difficult to react quickly to a road hazard.
Visual-spatial orientation problems can result in:
Problems judging distances (e.g., gauging the distance to a stop sign or traffic light)
Keeping the car in the correct lane
Driving too far to one side of the road
Difficulty scanning the road
Difficulty spotting and interpreting traffic signs
Problems identifying roadside landmarks
Difficulty distinguishing shapes
Concentration difficulties are common among people with Parkinson's disease, and they also have difficulty attending to multiple tasks. Naturally distractions from passengers, radio, and traffic can be taxing.
Fatigue and sudden sleep attacks while driving are often caused by PD medications, particularly dopamine-agonists. Patients who are excessively sleepy fall asleep suddenly, and have no recollection of being drowsy before falling asleep.
On-off fluctuations in physical symptoms due to PD medications.
Muscle stiffness contributes to:
A limited range of motion, particularly in the neck
Dystonia (muscle-cramping) in the toes
Rigid muscles that affect the ability to turn the steering wheel, use the gas pedal, push down the brake, and make quick movements
Strengthening Driving Skills
With PD, my driving skills are a little more limited, and I need to compensate. Driving is important to me to maintain my independence and self-esteem. I fear the isolation and dependency when I stop driving. To keep me and others safe on the road I've come up with some compensation strategies.
A couple of years ago, I traded my stick shift car for an automatic which has helped with my multi-tasking problems.
Some of my PD driving problems have lessened with deep brain stimulation (DBS) surgery and with proper programming of the neurostimulator. I no longer have muscle-cramped toes while driving (you can imagine how difficult it was to push down the gas pedal or hit the brake pedal). Also, my on-off fluctuations in medications have decreased.
Fortunately, the sudden sleep attacks I experienced as a passenger in a car (and thankfully not as a driver) have stopped, because I’ve discontinued taking Mirapex, a dopamine agonist.
I’ve also set limitations and choose to restrict my driving by:
Planning my itinerary before leaving the house
Driving in the day only
Driving on well-known routes and back roads, and avoiding the freeways, if possible
Driving when there is less traffic
Driving in good weather conditions, if possible–no snow, ice, or heavy rain
Driving without passengers
Avoiding distractions by turning the radio and CD player off (It’s obvious, but I should mention no eating or using a cell phone while driving.)
Researching the topic of driving with PD has scared me into enrolling in the AARP course, 55 Alive Driver Safety Program.
To improve my driving skills, I will also contact the Association of Driver Rehabilitation Specialists at 1-800-290-2344.
Once the snow stops pounding in Colorado, I intend to take an on-road driving test through a private driving organization.
I want to confront this taboo topic of driving with Parkinson's disease. By understanding and dealing with my deficits as a driver with Parkinson's disease, I can update my driving skills, or recognize when the time comes to give up driving altogether.
My article was first published in Parkinson's Hope Digest in January 2008.