いつも楽しく勉強させていただいている「ここが知りたい！高齢者診療のエビデンス」シリーズの第三話は認知機能低下と運転についてでした。

［第3回］認知機能低下，運転は大丈夫？

認知機能と運転能力は必ずしも相関しないんですね。警察からの指示で、高齢者の認知機能を評価しなければならないことがあるので、色々と考えさせられます。2016年6月2日に発表された論文にも、同じようなことが書いてありました。

Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review

The findings from this review support the use of composite batteries comprising multiple individual tests from different cognitive domains in predicting driving performance for individuals with dementia. Scores on individual tests or tests of a single cognitive domain did not predict driver safety. The composite batteries that researchers have examined are not clinically usable because they lack the ability to discriminate sufficiently between safe and unsafe drivers. Researchers need to develop a reliable, valid composite battery that can correctly determine driver safety in individuals with dementia.

話は変わりますが、認知症といえば、最近下記の論文を知って驚きました。この研究によると、脳出血後なんと 5人に1人が半年以内に認知症を発症するんですね。平均 74.3歳ですが、明らかに高頻度だと思います。なお、脳出血後の半年間に認知症を発症しなかった場合の認知症発症リスクは年間 5.8%だったそうです。(JAMA Neurology, 2016.6.13 published online)

Risk Factors Associated With Early vs Delayed Dementia After Intracerebral Hemorrhage

Among 738 patients who had experienced ICH (mean [SD] age, 74.3 [12.1] years; 384 men [52.0%]), 140 (19.0%) developed dementia within 6 months. A total of 435 patients without dementia at 6 months were followed up longitudinally (median follow-up, 47.4 months; interquartile range, 43.4-52.1 months), with an estimated yearly incidence of dementia of 5.8% (95% CI, 5.1%-7.0%). Larger hematoma size (hazard ratio [HR], 1.47 per 10-mL increase; 95% CI, 1.09-1.97; P < .001 for heterogeneity) and lobar location of ICH (HR, 2.04; 95% CI, 1.06-3.91; P = .02 for heterogeneity) were associated with EPID but not with DPID. Educational level (HR, 0.60; 95% CI, 0.40-0.89; P < .001 for heterogeneity), incident mood symptoms (HR, 1.29; 95% CI, 1.02-1.63; P = .01 for heterogeneity), and white matter disease as defined via computed tomography (HR, 1.70; 95% CI, 1.07-2.71; P = .04 for heterogeneity) were associated with DPID but not EPID.

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