Altered driving performance of symptomatic Huntington’s disease gene carriers in simulated road conditions

Abstract

Objective: In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments. Methods: This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups. Results: Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway. Conclusions: Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD. ARTICLE HISTORY

Driving Impairment in Movement Disorders

“…In a study performed by the same investigators, there seemed to be cognitive changes on neuropsychological testing in symptomatic patients with HD revealing signs of impaired driving on on‐road testing. Both motor domains (including body sway, finger tapping, and Unified Huntington's Disease Rating Scale (UHDRS)) along with cognitive domains (including Stroop interference, TMT‐B, Stroop word, and Stroop color) were highly correlated with standard deviation from the lateral position 59 . These and other studies 57–59,61–63 failed to identify specific clinical feature of HD impacting driving.…”

“…Symptomatic HD patients had identifiably slower speed along with significant variability of speed maintenance with high standard deviation from lateral position when tested using a driving simulator. There was a statistically significant risk of crash in patients with symptomatic HD when compared to presymptomatic HD or healthy controls 59 . In a study performed by the same investigators, there seemed to be cognitive changes on neuropsychological testing in symptomatic patients with HD revealing signs of impaired driving on on‐road testing.…”

“…In this study, HD was associated with specific driving impairments including vehicle control, problems with left turns at intersections and in merging into traffic. In another study, 30 patients with symptomatic HD were compared to 28 patients with pre‐symptomatic HD and 29 healthy controls 59 . Symptomatic HD patients had identifiably slower speed along with significant variability of speed maintenance with high standard deviation from lateral position when tested using a driving simulator.…”

Fit for purpose of on-the-road driving and simulated driving: A randomised crossover study using the effect of sleep deprivation

“…Simulated driving. The simulated driving test was performed on a fix-based driving simulator (Drivemaster, Green Dino B.V., the Netherlands) [9,18]. Each experiment session lasted for 20 minutes of driving on a two-lane highway with traffic.…”

Buckle up!

“…Auch Bereiche, in denen eine verkehrsmedizinische Beurteilung in der gesamthaften Einordnung der Fahrfähigkeit und -eignung erhebliche Erfahrung und bisher fachübergreifende Konsensrichtlinien benötigt, wurden teilweise mithilfe der FS untersucht. Hier sind beispielhaft Studien aus den Bereichen Ophthalmologie [45][46][47][48], Neurologie (multiple Sklerose [49,50], M. Parkinson [51], Huntington-Chorea [52,53], "mild cognitive impairment" und M. Alzheimer [54][55][56]) sowie der Psychiatrie (Depression [57,58]…”