Patients with Milder Weaknesses Show Ability to Drive in Simulator Study

Amyotrophic lateral sclerosis (ALS) patients with mild to moderate disease progression show an ability to drive that’s comparable to other adults, despite weaknesses with movement and cognition, a small study using a driving simulator suggests.

The study included only patients who were still driving, and its researchers caution that these findings “do not imply that ALS patients are ‘safe’ drivers.”

The study, “Comparison of driving capacity among patients with amyotrophic lateral sclerosis and healthy controls using the lane change task,” was published in the Journal of Neurological Sciences.

Driving is important for personal independence and social mobility, but the need for substantial visual, motor, and cognitive control often leads ALS patients to stop driving at some point.

Many patients and their family members turn to healthcare professionals for advice regarding a “right time” to stop driving. But assessing an ALS patient’s driving capacity can be difficult.

A few guidelines are available for individuals with neurodegenerative diseases, but the rapid pattern of decline in motor skills  separates people with ALS from those with other neurodegenerative diseases.

Researchers at the University of Utah sought to compare the abilities of people with ALS who reported they were still driving with healthy adults around the same age, serving as controls.

Patents underwent assessment of cognitive and behavioral skills, gait speed, and disease severity was measured using the ALS Functional Rating Scale-revised total score (ALSFRS-R).

Driving skills were assessed the Lane Change Task (LCT), a standardized computer program that simulates the visual, cognitive, and motor demands of highway driving to detect at-risk drivers.

“Since individuals with ALS may have difficulty performing motor skills and potentially demonstrate impairment in cognitive function, this type of assessment we felt could identify driving concerns,” the researchers wrote.

Their study enrolled 28 patients (22 males, average age of 64) and 20 controls (seven males, average age of 59). Patients had an average ALSFRS-R score of 36.2 points — representing mild to moderate functional decline. They were described as having “mildly slower mobility … [and] mild cognitive decline.”

Researchers, in analyzing results, found no differences in patients’ ability to drive in tasks that measured perception, driving quality, and ability to stay in a lane, including under distracting conditions.

“Driving performance of individuals with ALS who have mild to moderate disease progression, including mild cognitive decline and motor weakness, was not statistically different from driving capacity as healthy controls when measured using a driving simulation task,” they wrote.

Still, the researchers caution that this does not mean that ALS patients are necessarily “safe” drivers, as a simulator hardly mimics the complexity of real-world driving, such as weather and unpredictable scenarios.

They concluded that “with disease progression [a] referral for an on-road driving assessment is warranted.”