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Suicide by gunshot while driving a motor vehicle. Two additional cases.

Suicide by means of a motor vehicle occurs more frequently than is generally realized, and may be difficult to prove. Suicide by other means while driving a motor vehicle is far less frequent. Only two cases of suicide by gunshot while driving an automobile have been previously, and recently, reported. The author reports two additional cases of suicide by gunshot while driving a motor vehicle. Each case was a young man who had been suffering from depression; who obtained a firearm apparently for the express purpose of committing suicide; and who shot himself while driving a motor vehicle on an Interstate highway. Contrary to the usual finding in a series of suicides, three of the four cases now reported each left a suicide note or notes. What is apparently a fatal single-vehicle-single-occupant vehicular mishap may in fact be a suicide at the wheel by other means. What is apparently suicide by means of motor vehicle may in fact be an attempt to disguise homicide. Medicolegal offices are urged to routinely perform complete autopsies in fatal single-vehicle-single-occupant vehicular mishaps so that cause and manner of death may be documented without question.

Accidents, Traffic↗

Parkinson's disease and driving ability.

OBJECTIVES: To explore the driving problems associated with Parkinson's disease (PD) and to ascertain whether any clinical features or tests predict driver safety. METHODS: The driving ability of 154 individuals with PD referred to a driving assessment centre was determined by a combination of clinical tests, reaction times on a test rig and an in-car driving test. RESULTS: The majority of cases (104, 66%) were able to continue driving although 46 individuals required an automatic transmission and 10 others needed car modifications. Ability to drive was predicted by the severity of physical disease, age, presence of other associated medical conditions, particularly dementia, duration of disease, brake reaction, time on a test rig and score on a driving test (all p<0.001). The level of drug treatment and the length of driving history were not correlated. Discriminant analysis revealed that the most important features in distinguishing safety to drive were severe physical disease (Hoehn and Yahr stage 3), reaction time, moderate disease associated with another medical condition and high score on car testing. CONCLUSIONS: Most individuals with PD are safe to drive, although many benefit from car modifications or from using an automatic transmission. A combination of clinical tests and in-car driving assessment will establish safety to drive, and a number of clinical correlates can be shown to predict the likely outcome and may assist in the decision process. This is the largest series of consecutive patients seen at a driving assessment centre reported to date, and the first to devise a scoring system for on-road driving assessment.

Age Factors↗

The impact of Alzheimer's disease on driving ability: a review.

As our elderly population continues to increase, diseases that are more prevalent with aging, such as Alzheimer's disease, are assuming ever greater relevance for society and the practicing clinician. An important practical situation faced by physicians caring for individuals with Alzheimer's disease is advising the affected individuals, their families, and often the licensing authorities about whether the patient can safely drive an automobile. Surprisingly, there is little guidance on how to arrive at a clinical impression of the fitness of an individual with Alzheimer's disease to drive. This article outlines potential inadequacies in driving skills that may occur with elderly people in general, and more specifically those with Alzheimer's disease. Studies that focused on Alzheimer's disease and driving are then reviewed. We conclude with recommendations for dealing with the problem of driving abilities in Alzheimer's disease.

Accidents, Traffic↗