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DRIVING SIMULATION PERFORMANCE PREDICTS FUTURE ACCIDENTS AMONG OLDER DRIVERS
Author(s) -
Cox Daniel J.,
Taylor Peter,
Kovatchev Boris
Publication year - 1999
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1999.tb03017.x
Subject(s) - medicine , injury prevention , poison control , psychological intervention , suicide prevention , human factors and ergonomics , occupational safety and health , population , environmental health , intervention (counseling) , risk assessment , gerontology , medical emergency , computer security , computer science , psychiatry , pathology
malnutrition. Patient history is important, especially in regard to dietary habits and medications and including alcohol consumption. Symptoms of hypoglycemia may be hyperepinephrinemic or neuroglycopenic. Neuroglycopenic symptoms usually occur when hypoglycemia develops gradually and finally reaches low levels (40 mg/dL). These symptoms include headache, diplopia, confusion, inappropriate affect, motor incoordination, and, when severe, seizures, coma, and, ultimately, death. The symptoms in our case, developing over a period of years, strongly suggest a neuroglycopenic basis. Hyperepinephrinemic symptoms (palpitations, sweating, tremor, hunger) were not evident in our patient. Age-related changes in carbohydrate metabolism result in mild glucose intolerance. There is a decreased rate of glucose absorption with aging that is associated with delayed insulin release.2 Insulin resistance is also described in older people. Theoretically, older people should be protected from developing hypoglycemia if they are not taking insulin or oral hypoglycemic agents. One study has suggested that healthy older people may have impaired release of glucogon and epinephrine in response to hypoglycemia, blunting their protective r e ~ p o n s e . ~ Older people tend to manifest fewer hyperepinephrinemic than neuroglycopenic symptoms, as seen in our case. There is very little information available about the neurological effects of recurrent hypoglycemia in nondiabetic older people. Hypoglycemia appears to be a rare cause of dementia? In the absence of data, the role of recurrent hypoglycemia in cognitive deterioration is difficult to gauge. Although hypoglycemia can be corrected, neuronal death does not reverse. The medical profession should strive to detect and treat recurrent hypoglycemia in the geriatric population.