Laurence Paire-Ficout

The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging

Aims: Our purpose was to identify cognitive tools associated with unsafe driving among elderly drivers of varying cognitive levels. Methods: Twenty drivers with early-stage dementia of the Alzheimer type and 56 nondemented drivers aged 65–85 were recruited. Various cognitive processes were measured and unsafe driving was evaluated during an in-traffic road test with 3 different indicators and a composite indicator. Results: The Wechsler Digit Symbol Substitution Test score was the best cognitive measure to detect unsafe drivers using the composite driving indicator. Conclusion: The Digit Symbol Substitution Test may be used by physicians for the evaluation and follow-up of older patients, with or without Alzheimer-type dementia, as a screening tool of unsafe driving.

Impact of specific executive functions on driving performance in people with Parkinson's disease

Executive functions encompass various cognitive processes and are critical in novel or demanding driving situations. Our aim was to determine the role of impairments in specific executive functions (updating, flexibility, inhibition) on road performance in drivers with Parkinsons disease (PD), a condition commonly associated with early executive dysfunction. In this pilot study, 19 patients with mild to moderate PD and 21 healthy controls matched for age, education, and driving experience were tested using a neuropsychological battery assessing global cognitive abilities, updating (n‐back task), flexibility (plus‐minus task), and inhibition (Stroop test). Participants also underwent a 45‐minute road test in which they were scored by a driving instructor and a second experimenter. To separate “at‐risk” drivers from safe drivers, a composite driving indicator was calculated from the Test Ride for Investigating Practical Fitness to Drive score, the penalty score from the observation grid, and the number of safety interventions made by the driving instructor. Eight of the 40 drivers (all PD) were rated as “at risk.” Measures of updating (the n‐back task) and mental flexibility (the plus‐minus task) predicted driving safety even after adjustment for group status, explaining 53% of the total variance. These 2 tests also discriminated between safe and “at‐risk” drivers within the PD group. These findings, although preliminary, suggest that updating and mental flexibility are critical for safe driving in PD. Assessment batteries for driving fitness should probe different aspects of executive functions, specifically when evaluating drivers with PD.

Relationships between Cognitive Functions and Driving Behavior in Parkinson’s Disease

Alterations in cognitive functions in Parkinson’s disease (PD) have been reported even in mild stages of the disease. These functions may play a role in complex daily activities, such as driving. This article provides an overview on the relationships between cognitive functions and driving behavior in PD in driving simulator and on-road studies. The role of attention, executive functions, visual memory, visuospatial construction and information processing speed is discussed. In driving simulator studies, driving performances were correlated with several neuropsychological measures, especially those of Trail Making Test (TMT), Brixton and Symbol Digit Modalities Test. In on-road studies, TMT, Useful Field Of View and Block Design tests appear as good predictors of driving performances. Most of these tests are also relevant to driving in Alzheimer’s disease and traumatic brain injury.

Dissociation between the cognitive process and the phenomenological experience of TOT: effect of the anxiolytic drug lorazepam on TOT states.

TOT states may be viewed as a temporary and reversible microamnesia. We investigated the effects of lorazepam on TOT states in response to general knowledge questions. The lorazepam participants produced more commission errors and more TOTs following commission errors than the placebo participants (although the rates did not change). The resolution of the TOTs was unimpaired by the drug. Neither feeling-of-knowing accuracy nor recognition were affected by lorazepam. The higher level of incorrect recalls produced by lorazepam participants may be due to the fact that they were more frequently temporarily unable to access a known item. For some of these items, the awareness of the retrieval failure resulted in a commission TOT (phenonemological TOT after a commission error). The resolution of the TOT conflict is discussed in the light of the anxiolytic and anticonflict effects of lorazepam. The data are discussed in terms of contemporary theories of TOTs and the effects that benzodiazepines have on semantic memory.

Research Report: Don't miss your train! Just follow the computer screen animation: Comprehension processes of animated public information graphics

Computer graphic animated information displays have the potential to communicate public information in situations where normal announcement types are ineffective. This study used eye tracking techniques to analyze comprehension mechanism of event-related information on railway traffic disruptions presented via different graphic formats presented on computer screen. 86 participants were asked to understand series of traffic disruption messages delivered via four purely visual formats: Static simultaneous, Static sequential, Animated simultaneous and Animated sequential. Across these four conditions, and contrary to the most common materials used in the studies on animation comprehension, the sequentiality and the animated properties of the entities of the presentation were not confounded. Results revealed the Animated sequential displays were the most effective presentation type. Eye tracking data showed why an animation facilitates comprehension of public information graphics: it enhances processing strategies which provide the best condition for segmenting and composing the causal chain of the events provided in the message.

Emotional experiences one year after a traffic accident: An exploratory study of verbatim accounts of the ESPARR cohort

The aim of this study was to characterize different possible profiles of emotional experiences of victims of traffic accident based on verbatim accounts collected one year after the accident, and to relate these profiles to various socio-demographic and health data. A hierarchical cluster analysis of the emotional lexicon was made by categorizing and quantifying the EMOTAIX© lexicon using Tropes© text analysis software. Out of the 751 selected subjects, 328 expressed one or more emotional experiences. A link appeared between quality of life (QoL), post-traumatic stress disorder (PTSD) and the valence of expressed emotions. Injury severity and history distinguished two sets expressing negative-valence emotional experience. Paradoxically, a group also emerged with a large proportion of severely injured persons, associated with the expression of positive-valence emotional experiences and with domains of QoL and PTSD. The analysis of subjective data sheds light on the experience of traffic accident victims and shows a way forward for research and clinical intervention.