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PubMed2002

Different activation dynamics in multiple neural systems during simulated driving.

Driving is a complex behavior that recruits multiple cognitive elements. We report on an imaging study of simulated driving that reveals multiple neural systems, each of which have different activation dynamics. The neural correlates of driving behavior are identified with fMRI and their modulation with speed is investigated. We decompose the activation into interpretable pieces using a novel, generally applicable approach, based upon independent component analysis. Some regions turn on or off, others exhibit a gradual decay, and yet others turn on transiently when starting or stopping driving. Signal in the anterior cingulate cortex, an area often associated with error monitoring and inhibition, decreases exponentially with a rate proportional to driving speed, whereas decreases in frontoparietal regions, implicated in vigilance, correlate with speed. Increases in cerebellar and occipital areas, presumably related to complex visuomotor integration, are activated during driving but not associated with driving speed.

Adult↗
PubMed2004

Alcohol continues to affect sleepiness related driving impairment, when breath alcohol levels have fallen to near-zero.

Epidemiological findings point to very low blood alcohol levels heightening the risk of sleep-related fatal road crashes. This was further assessed using a full sized interactive car simulator. Twenty, sleep restricted, healthy young men underwent a 2 h simulated afternoon monotonous drive, having previously consumed nil alcohol or 3 units >90 min previously, and having near-zero breath alcohol (BrACs) at the start of the drive. In a repeated measures, double-blind, balanced design, driving performance, subjective sleepiness and EEG were monitored throughout. Compared with nil alcohol, the alcohol condition initially increased sleepiness-related driving impairment. However, this was not mirrored by subjective sleepiness or EEG. An unexpected reversal (i.e. improvement) in driving impairment occurred with the alcohol group, in the second hour of the drive. This was supported by a trend for improved subjective alertness. Alcohol continued to interact with sleepiness-related driving impairment after BrACs had reached zero. However, a lack of subjective perception of increased sleepiness, at this time, further points to the dangerous combination of even modest alcohol intake and sleepiness, and confirms the road crash findings. BrACs are a poor guide to driver impairment.

Adult↗
PubMed2005

Effects of prolonged wakefulness combined with alcohol and hands-free cell phone divided attention tasks on simulated driving.

Simulated driving ability was assessed following administration of alcohol, at an estimated blood level of 0.05%, and combined prolonged wakefulness, while participants were undertaking divided attention tasks over a hands-free mobile phone. Divided attention tasks were structured to provide a sustained cognitive workload to the subjects. Twenty three young healthy individuals drove 10 km simulated driving under four conditions in a counterbalanced, within-subject design: alcohol, alcohol and 19 h wakefulness, alcohol and 24 h wakefulness, and while sober. Study measures were: simulated driving, self-reported sleepiness, critical flicker fusion threshold (CFFT), Stroop word-colour interference test (Stroop) and simple visual reaction times (SVRT). As expected, subjective sleepiness was highly correlated with both sleep restriction and alcohol consumption. The combination of alcohol and 24 h sustained wakefulness produced the highest driving impairment, significantly beyond the alcohol effect itself. Concurrent alcohol and 19 h wakefulness significantly affected only driving time-to-collision. No significant changes of study measures occurred following alcohol intake in unrestricted sleep conditions. CFFT, SVRT and Stroop results showed a similar trend in the four study conditions. Thus apparently 'safe' blood alcohol levels in combination with prolonged wakefulness resulted in significant driving impairments. In normal sleep conditions alcohol effects on driving were partially counteracted by the concomitant hands-free phone based psychometric tasks.

Accidents, Traffic↗
PubMed1984

Simulated car driving as a useful technique for the determination of residual effects and alcohol interaction after short- and long-acting benzodiazepines.

SUBJECTS AND METHODS: 54 healthy volunteers took part in 3 placebo controlled double-blind trials designed partly as crossover, partly as parallel group studies. The long-acting (elimination half-life greater than 24 h) test drugs diazepam (DIA 5; 10 mg) and flurazepam (FLU 30 mg) were compared to the short-acting drugs (elimination half-life less than 12 h) lormetazepam (LOR 1.5; 2 mg) and mepindolol sulfate (MEP 10 mg; betablocker) following acute or subchronic application. Alcohol (ALC; 0.4-0.8 per mill blood ALC concentration) was used as a compound interfering with the test drugs. Measurements with the driving simulator TS2 were taken at different times between 1 h and 15 h p.a. RESULTS: Subchronic use of FLU causes significant impairment of driving performance the next morning in contrast to LOR which even increases the driving ability. The ALC potentiating effect of LOR is larger than that of DIA after acute intake. MEP acts like placebo but reduces blood pressure and heart rate. Interaction of LOR and ALC in the evening does not result in a prolonged hangover effect which could disturb driving performance the next morning. DISCUSSION: Short-acting benzodiazepines without active metabolites have a profound advantage over those with long-acting accumulating characteristics in respect to matutinal car driving ability, if those drugs are used as nighttime hypnotics. These results highlight the necessity of screening hypnotic and tranquilizing drugs concerning their influence on car driving performance at different times after intake and under conditions of interactions with psychotropic drugs, especially alcohol. In view of future methodological requirements a revised model of driving simulation is presented. It is based on a coherent description of the system "driver-vehicle environment" at the level of visual conditions, vehicle behaviour and driver performance. Preliminary data are shown.

Anti-Anxiety Agents↗
PubMed1984

A comparison of methods for assessing the sedative effects of diphenhydramine on skills related to car driving.

A double blind cross-over study was performed to compare the sensitivity of "oof road" driving with that of laboratory tests of driving-related skills to drug induced sedation. Twelve experienced drivers (6 M, 6 F) received single oral doses of the H1-antagonist diphenhydramine 25, 50 and 100 mg and placebo. Each treatment was administered on 2 separate occasions, once in the driving school when real driving skills were assessed and again in the laboratory when performance of an adaptive tracking task, body sway and visual reaction were measured. On all occasions subjects assessed their own performance and alertness/sedation using visual analogue scales. Data were subjected to analysis of variance and differences assessed by Newman Keul's test. Diphenhydramine failed to impair driving performance at any dose while all doses produced significant changes in each of the 3 laboratory tests. Subjects rated themselves sedated after all 3 doses of active drug in the laboratory but only after the 100 mg dose in the driving school. Tests performed in the psychopharmacology laboratory appear to be more sensitive to the sedative effects of diphenhydramine than tests of "off road" driving. The implications are discussed.

Adult↗
PubMed2003

General anesthesia does not impair simulator driving skills in volunteers in the immediate recovery period - a pilot study.

PURPOSE: The current recommendations to refrain from driving for 24 hr after general anesthesia (GA) lack evidence. Our objective was to measure impairment of driving performance at various time intervals after anesthesia using driving impairment at different blood alcohol concentrations (BAC) as a gold standard for comparison. METHODS: Institutional Review Board approval was obtained. A cross-over design, within subject comparison was used. Twelve volunteers were randomized to three treatments: GA, alcohol, and no drug. Psychomotor recovery was assessed by Digit Symbol Substitution Test (DSST) and Trieger Dot Test (TDT). On the anesthetic day, GA was induced with propofol 2.5 mg x kg(-1) and fentanyl l micro g x kg(-1) and maintained with N(2)O-O(2) 50:50 and approximately one minimum alveolar concentration of desflurane by spontaneous ventilation for 30 min. Driving simulator test runs occurred at two, three, four, and 24 hr postanesthesia. On the alcohol treatment day, a vodka and orange juice beverage was administered to reach the legal limit for BAC in the province of Ontario, Canada (BAC 0.08%). On the control day, no drug was given. Driving simulator test runs corresponded to the same time of day as the postanesthetic test runs. Two-way analysis of variance for dependent samples (ANOVA) was performed using the SAS program. P values of less than 0.05 were considered significant. RESULTS: There was no significant difference in postanesthetic driving skills at two, three, and four hours postanesthesia, and the corresponding control sessions. There was no significant difference among the three sessions with respect to pen and paper tests of psychomotor performance. Performance during the alcohol session differed significantly from that during the control and postanesthetic sessions. CONCLUSION: Certain driving skills return by two hours after one half hour of GA of propofol, desflurane, and fentanyl in a group of young volunteers.

Adult↗
PubMed2003

Driving ability after acute and sub-chronic administration of levocetirizine and diphenhydramine: a randomized, double-blind, placebo-controlled trial.

RATIONALE: Sedation following antihistamine use poses a danger to ambulant patients involved in daily activities such as driving. OBJECTIVE: To investigate effects of levocetirizine (5 mg), diphenhydramine (50 mg), and placebo on driving ability during normal traffic. METHODS: Forty-eight healthy volunteers participated in a double-blind, placebo-controlled, randomized clinical trial. Treatments were administrated on days 1, 2, 3 and 4, exactly 1.5 h before the start of the standardized driving test (performed on day 1 and day 4). In the standardized driving test, subjects were instructed to drive with a steady lateral position, while maintaining a constant speed (95 km/h). Primary parameter was the standard deviation of lateral position (SDLP; cm). Statistical analyses were performed separately for day 1 and day 4, using analysis of variance and an equivalence test. Equivalence to placebo was evidenced if the 95% confidence interval lay between -2.6 cm and +2.6 cm. RESULTS: SDLP after levocetirizine was equivalent to placebo on both day 1 (-0.66 cm; +1.12 cm) and day 4 (-0.37 cm; +1.28 cm). In contrast, SDLP after diphenhydramine differed significantly from placebo on both day 1 ( P<0.0001) and day 4 ( P<0.0003). On day 1, the 95% confidence interval of diphenhydramine (+1.85 cm; +3.63 cm) was partially above the upper equivalence limit (+2.6 cm), indicating clinically relevant driving impairment. On day 4, however, the 95% confidence interval of diphenhydramine (+0.74 cm; +2.38 cm) was contained within the acceptance range. CONCLUSION: In contrast to diphenhydramine, driving performance was not significantly affected while using 5 mg levocetirizine once daily.

Adult↗
PubMed2006

Driving impairment in depressed patients receiving long-term antidepressant treatment.

BACKGROUND: Depression is a common mental disorder with cognitive deficits, but little information is available on the effects of antidepressant treatment on driving performance in depressed patients. AIMS: Assessing actual driving performance and cognition of depressed patients receiving long-term antidepressant treatment. MATERIALS AND METHODS: Performance was assessed in depressed patients receiving selective serotonin reuptake inhibitor (SSRI) or serotonin and noradrenalin reuptake inhibitor (SNRI) treatment for 6-52 weeks and in matched healthy controls by means of two standardised on-the-road driving tests and laboratory tests of cognition. RESULTS: Data showed poorer driving performance as indicated by a higher standard deviation of lateral position or 'weaving motion' in medicated patients relative to controls. Time to speed adaptation and critical flicker fusion threshold were also impaired in medicated patients. The Hamilton Depression Rating Scale scores in medicated patients were significantly higher as compared to that of controls. No other significant results between the two groups were demonstrated on the variables of the driving tests and laboratory tests of cognition. CONCLUSIONS: The depressed patients receiving long-term treatment with SSRI- and SNRI-type antidepressants show impaired driving performance. This impairment in driving performance can probably be attributed to residual depressive symptoms instead of the antidepressant treatment.

Adrenergic Uptake Inhibitors↗
PubMed2007

Cognitive, psychomotor and actual driving performance in healthy volunteers after immediate and extended release formulations of alprazolam 1 mg.

RATIONALE: Alprazolam extended-release (XR) is approved for the treatment of panic disorder. This sustained formulation is absorbed in a delayed manner and is therefore expected to produce fewer and less severe side effects than its immediate release equivalent (alprazolam IR). The effect of alprazolam XR on potentially dangerous daily activities, such as driving a car, is expected to be less as compared to alprazolam IR. OBJECTIVES: The present study was designed to compare the effects of alprazolam XR (1 mg) and alprazolam IR (1 mg) on actual driving ability and cognitive function. METHOD: Eighteen healthy volunteers (aged 20-45 years) participated in a double-blind, placebo-controlled, three-way crossover study. At 4 h post-dose, subjects performed a standardized driving test on a primary highway in normal traffic. Cognitive and psychomotor tests were assessed 1, 2.5, and 5.5 h post-dose. Memory functioning was measured only 1 h after administration. RESULTS: Both formulations severely impaired driving performance between 4 and 5 h after administration. The magnitude of impairment in the driving test observed with alprazolam XR was about half that observed with alprazolam IR. Laboratory test results were in line with the driving data. CONCLUSIONS: The acute impairing effects of alprazolam XR 1 mg on driving and psychomotor functions were generally less, as compared to its immediate-release equivalent, but still of sufficient magnitude to increase the risk of becoming involved in traffic accidents.

Adult↗
PubMed1990

The application of learning theory to driving confidence: the effect of age and the impact of random breath testing.

Despite the dangers, many drivers continue to take risks when driving. This paper outlines an explanation of this risk-taking behavior and the failure of numerous fear-arousing messages to change the manner in which many people drive. Being an occupant in a car and learning to drive may be seen as analogous to systemic desensitization and flooding procedures, in which fear is extinguished and/or a response inconsistent with fear is learned. Once this procedure is complete the fear response is unlikely to be reinstated by messages pointing out possible dangers on the road, because the situations in which the messages are received are usually inappropriate, and many believe that they are superior drivers and therefore not at risk. News presentation of the huge road toll and multiple fatality crashes may only confirm to many people that they are better than average drivers since so many other people have been killed or seriously injured, and they, the superior drivers, have not. A prediction of this account is that driving confidence will increase with increasing age, through the greater on-road fear-reducing experience and increased exposure to the road toll. This prediction was examined in surveys of 2,963 Australian drivers, conducted as part of the evaluation of random breath testing. Respondents were asked to rate their ability as drivers compared with average, and to rate their ability to drive under the influence of alcohol. The overconfidence observed in Canada, Sweden, New Zealand, and the United States was identified in Australian drivers. The predicted increase in confidence with increasing age was supported up to the age of 40 years, after which confidence changed little. Confidence in ability to drive after consuming alcohol increased steadily with age. Finally, it was predicted that the introduction of random breath testing and the associated media campaign partly about the effects of alcohol (which was successful in reducing the road toll) would decrease confidence in ability to drive under the influence of alcohol. Comparison of survey data before and after the introduction of random breath testing did not support this prediction.

Accidents, Traffic↗
PubMed1991

The visual and driving performance of monocular and binocular heavy-duty truck drivers.

This study compared the performance of 40 monocular and 40 binocular tractor-trailer drivers on measures of both visual and driving performance. On the visual measures, the mononuclear drivers were significantly deficient in contrast sensitivity, visual acuity under low illumination and glare, and binocular depth perception. They were not significantly deficient in static or dynamic visual acuity, visual field of individual eyes, or glare recovery. Driving measures of visual search, lane keeping, clearance judgment, gap judgment, hazard detection, and information recognition showed no differences between monocular and binocular drivers. Monocular drives were poorer than binocular drivers only in sign reading distance in both daytime and nighttime driving. This decrement correlated significantly with the binocular depth perception measure. There were large individual differences within each group for most of the visual and driving performance measures. It was concluded that monocular drivers have some significant reductions in selected visual capabilities and in certain driving functions dependent on these abilities, compared with binocular drivers. However, monocular drivers are not significantly worse than binocular drivers in the safety of most day-to-day driving functions. Implications of these findings and the large individual differences within each group are discussed.

Adult↗
PubMed1992

Multiday driving patterns and motor carrier accident risk: a disaggregate analysis.

A method has been developed to estimate the relative accident risk posed by different patterns of driving over a multiday period. The procedure explicitly considers whether a driver is on duty or off duty for each half hour of each day during the period of analysis. From a data set of over 1,000 drivers, nine distinct driving patterns are identified. Membership in the patterns is determined exclusively by the pattern of duty hours for seven consecutive days; for some drivers an accident occurred on the eighth day while others had no accident, therefore each pattern can be associated with a relative accident risk. Additional statistical modeling allowed the consideration, in addition to driving pattern, of driver age, experience with the firm, hours off duty prior to the last trip and hours driving on the last trip (either until the accident or successful completion of the trip). The finding of the modeling is that driving patterns over the previous seven days significantly affect accident risk on the eighth day. In general, driving during the early and late morning (e.g., midnight to 10 A.M.) has the highest accident risk while all seven other multiday patterns had indistinguishable risk. Consecutive hours driven also has a significant effect on accident risk: the first hour through the fourth hour having the lowest risk with a fluctuating increase in risk to a maximum beyond nine hours. Driver age and hours off duty immediately prior to a trip do not appear to affect accident risk significantly. These findings quantitatively assess the relative accident risk of multiday driving patterns using data from actual truck operations. Further research is recommended in the areas of refining model structures, adding explanatory variables (such as highway type), and testing more complex models.

Accidents, Occupational↗
PubMed1994

The connection between risky driving and involvement in fatal accidents.

The connection between risky driving and involvement in fatal accidents was investigated in two studies using two data sets. The first study compared the recorded offenses of 615 drivers involved in fatal accidents with a sample of drivers randomly selected from driver records. The second study compared the recorded offenses of 143 drivers stopped by the police for risky driving with the prior records of control drivers stopped at the same locations. The drives involved in fatal accidents and the drivers stopped for risky driving had violated traffic regulations more often than other drivers. Those responsible for causing fatal accidents as well as involved but nonculpable drivers had previously been convicted of traffic offenses more often than other drivers. Among the fatal-accident drivers, those involved in running-off-the-road accidents had accumulated the largest number of traffic offenses. There appears to be a particular link between the age and the prior offense rate of the two risk groups. For under-35-year-olds, the offense rate (offenses/million kilometers) of those stopped for risky driving and those involved in fatal accidents were about the same. For over-35-year-olds, the drivers stopped for risky driving had accumulated many times more speeding offenses than those involved in fatal accidents. Unlike the other groups the offense rate of those stopped for risky driving does not decrease with age.

Accidents, Traffic↗
PubMed1994

Seat-belt wearing and driving behavior: an instrumented-vehicle study.

Less-than-expected fatality reductions after seat-belt legislation has been introduced in a jurisdiction may be explained in terms of selective recruitment of parts of the driving population and/or behavioral adaptation by beginning belt users. The present investigation has compared the relative merits of these two hypotheses at the level of individual driver behavior. In the initial study the driving behavior of groups of habitual wearers and nonwearers of the belt was compared. Nonwearers made two trips, one with the belt on and one without the belt. Habitual wearers drove belted only. The main part of the experiment was a 105 km freeway route. Two additional tasks of a somewhat more critical nature, a double lane-change manoeuvre and the performance of a braking manoeuvre in front of a fixed obstacle, were performed after the freeway trips. Factor analysis on 39 variables describing driving behavior on the road and during the additional tasks resulted in five factors. One of these, the factor describing the distribution of driving speed on the freeway, differentiated between nonwearers and wearers (thus yielding support for the selective recruitment hypothesis) as well as between wearing and not wearing the belt by the same drivers (thus yielding support for the behavioral adaptation hypothesis). In the follow-up study the original wearers and nonwearers were assigned to one of four experimental treatments: (i) the promise by the experimenter of a considerable incentive for not having a culpable motor vehicle accident over a period of a year. Half the habitual wearer subjects were assigned to this condition. The expectation was that this group would become more careful in their driving; (ii) a control group, consisting of the remaining habitual wearers; (iii) the agreement between the experimenter and the subject that the latter would buckle up in everyday driving for the year to come--half the habitual nonwearer subjects were assigned to this condition; (iv) a control group to the previous treatment, consisting of the remaining habitual nonwearers. All subjects returned for repeat measurements, consisting of the freeway trips plus additional tasks, three times over the next year. The main result was that beginning wearers (group iii) showed signs of continuing behavioral adaptation, in the form of increased speed and increased propensity for close following, as well as several minor effects. The "incentive" group (group i), however, did not change driving behavior in the expected sense, i.e. in the safe direction.

Adaptation, Psychological↗
PubMed2006

Asymmetric relationship between driving and safety skills.

We hypothesized that the combination of self reported high ratings of driving skills and low ratings of safety skills creates a serious risk for road accident involvement. This study was aimed at investigating the asymmetric interplay between driving and safety skills among Turkish drivers (N=785) using the Driving Skills Inventory [Lajunen, T., Summala, H., 1995. Driver experience, personality, and skill and safety motive dimensions in drivers' self-assessments. Pers. Indiv. Differ. 19, 307-318]. The assumed asymmetric interactions were tested on a number of outcome variables representing risky driving using moderated regression analyses. The results revealed that driving skills moderated the effects of safety skills on six out of the eight outcome variables including the number of accidents, tickets, overtaking tendencies, speed on motorways, and aggressive driving style. Results suggested that high levels of safety skills buffer the negative effect of overconfidence resulting from exaggerated ratings of self-reported driving skills.

Accidents, Traffic↗
PubMed2006

Individual difference factors in risky driving: the roles of anger/hostility, conscientiousness, and sensation-seeking.

Motor vehicle crashes claim the lives of more Americans than any other cause of injury. One factor long recognized as relevant to predicting dangerous driver behavior is the driver's personality. This study examines the independent and combined roles of three personality traits--sensation-seeking, conscientiousness, and anger/hostility--in predicting risky driving behavior. Seventy-three participants completed personality and driving history questionnaires, and also engaged in a virtual environment (VE) task designed to assess risk-taking driving behavior. Each facet of personality was correlated to risky driving behavior in independent univariate analyses. In multivariate analyses, sensation-seeking emerged as the best predictor of self-reported driving violations. Anger/hostility and the interactive effect of anger/hostility by sensation-seeking also emerged in a multivariate analysis predicting one measure of self-reported driving violations. No personality trait predicted risky driving in the VE in multivariate analyses. Results are discussed with respect to previous work in the field, challenges involved in measuring the constructs of interest, and implications to prevention.

Accidents, Traffic↗
PubMed2006

Predicting risky and angry driving as a function of gender.

The present study was designed to examine putative risk factors of driving anger, traffic citations, and traffic-related injuries as a function of gender. Participants included 785 (65% men) drivers identified by the Washington State Department of Licensing. Just over half of participants (55%) were identified as high-risk drivers based on multiple traffic violations, whereas 45% were recruited from a random sample of drivers. Participants completed a mailed survey assessing indicators of risky driving and risk factors including sensation seeking, stressful events, negative affect, tobacco use, and drinking behavior. Hierarchical regression analysis was used to evaluate risky driving outcomes as a function of theoretically prioritized risk factors and to evaluate gender as a moderator. Overall, men reported more traffic citations and injuries, but did not differ from women in reported driving anger. All putative risk factors were associated with one or more indicators of risky driving. Moderation results revealed that the positive relationship between drinking frequency and driving anger was stronger for women. In contrast, typical number of drinks consumed was negatively associated with driving anger, which was also more evident for women. In addition, the positive association between sensation seeking and number of traffic citations was stronger among women.

Accidents, Traffic↗
PubMed2005

Driving strategies used by older adults with macular degeneration: assessing the risks.

Older adults with macular degeneration use multiple driving strategies. A secondary analysis focused on driving strategies was conducted on data from two studies that had explored the experience of visual impairment in older adults diagnosed with macular degeneration. Findings revealed 24 driving strategies. Twelve categories emerged, reflecting two themes: (1) strategies used while performing the task of driving and (2) strategies used to continue driving. By understanding these strategies, nurses can assess the conditions under which these older adults drive and the risks taken. Findings guide nurses to counsel and educate older adults regarding driving.

Activities of Daily Living↗