Background: The multimodal symptomatology of Parkinson disease (PD) appears to influence in a negative way aspects of cognition, behavior and motor control that are interwoven with the capacity of an individual to maintain adequate driving skills. Objective of the present review was to explore the link between cognition and driving fitness in patients with PD.

Methods: A systematic review of the literature was carried out for identifying relevant studies.

Results: Although it has not been sufficiently documented that drivers with PD have an increased rate of car crashes, according to multiple studies they face more difficulties than controls both on on-road and driving simulator evaluations. Notably, cognitive and not motor measures appear to be stronger predictors of driving performance in this clinical group. In particular, neuropsychological tests that engage executive, visuospatial and attentional resources are among the most sensitive predictors of the pass/fail outcome on driving evaluations.

Conclusions: Prospective studies by combining information from on-road and simulator driving could improve the validity properties of simulator assessments and expand our insight by exploring the unique contribution of broader sets of predictors. Also, an objective of future research should be the development of a wider array of cutoff scores with the use of larger and more representative samples that have the capacity to improve the accuracy of recommendations about future driving practices as well as of decisions about the restriction or total loss of driving privileges.