Examining virtual driving test performance and its relationship to individuals with HIV-associated neurocognitive disorders

Abstract

SignificanceExisting screening tools for HIV-associated neurocognitive disorders (HAND) are often clinically impractical for detecting milder forms of impairment. The formal diagnosis of HAND requires an assessment of both cognition and impairment in activities of daily living (ADL). To address the critical need for identifying patients who may have disability associated with HAND, we implemented a low-cost screening tool, the Virtual Driving Test (VDT) platform, in a vulnerable cohort of people with HIV (PWH). The VDT presents an opportunity to cost-effectively screen for milder forms of impairment while providing practical guidance for a cognitively demanding ADL.ObjectivesWe aimed to: (1) evaluate whether VDT performance variables were associated with a HAND diagnosis and if so; (2) systematically identify a manageable subset of variables for use in a future screening model for HAND. As a secondary objective, we examined the relative associations of identified variables with impairment within the individual domains used to diagnose HAND.MethodsIn a cross-sectional design, 62 PWH were recruited from an established HIV cohort and completed a comprehensive neuropsychological assessment (CNPA), followed by a self-directed VDT. Dichotomized diagnoses of HAND-specific impairment and impairment within each of the seven CNPA domains were ascertained. A systematic variable selection process was used to reduce the large amount of VDT data generated, to a smaller subset of VDT variables, estimated to be associated with HAND. In addition, we examined associations between the identified variables and impairment within each of the CNPA domains.ResultsMore than half of the participants (N = 35) had a confirmed presence of HAND. A subset of twenty VDT performance variables was isolated and then ranked by the strength of its estimated associations with HAND. In addition, several variables within the final subset had statistically significant associations with impairment in motor function, executive function, and attention and working memory, consistent with previous research.ConclusionWe identified a subset of VDT performance variables that are associated with HAND and assess relevant functional abilities among individuals with HAND. Additional research is required to develop and validate a predictive HAND screening model incorporating this subset.

Research priorities in HIV, aging and rehabilitation: Building on a Framework with the Canada-International HIV and Rehabilitation Research Collaborative

“…social isolation, mental health) and disrupted models of rehabilitation care delivery. Technology has been used widely for education, accessing health and rehabilitation services, and implementing interventions in the context of HIV; this includes smartphone and app technology to facilitate engagement in care, medication adherence, neurocognitive assessment, and exercise (26-29), virtual driving test platforms to assess the ability to drive among persons with HIV and neurocognitive impairment (30), and tele-health exercise interventions with adults aging with HIV (20,31,32). Arti cial intelligence also is used with older adults for remote patient monitoring and smart home technology (33)(34)(35), assessment of mobility with mobility disorders (36, 37) or dementia (38), as well as facilitating rehabilitation assessment and treatment in order adults (39).…”

Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative

“…social isolation, mental health) and disrupted models of rehabilitation care delivery. Technology has been used widely for education, accessing health and rehabilitation services, and implementing interventions in the context of HIV; this includes smartphone and app technology to facilitate engagement in care, medication adherence, neurocognitive assessment, and exercise [ 26 – 29 ], virtual driving test platforms to assess the ability to drive among persons with HIV and neurocognitive impairment [ 30 ], and tele-health exercise interventions with adults aging with HIV [ 20 , 31 , 32 ]. Artificial intelligence also is used with older adults for remote patient monitoring and smart home technology [ 33 – 35 ], assessment of mobility with mobility disorders [ 36 , 37 ] or dementia [ 38 ], as well as facilitating rehabilitation assessment and treatment in order adults [ 39 ].…”

Classification of Drivers with HIV-Associated Neurocognitive Disorders using Virtual Driving Test Performance Data

“…This was done in order to determine if the traits of drivers with HAND could be reliably detected and summarized, distinctly so from other forms of NCI. A more complete report of the recruitment and study visit procedures may be found in (Grethlein et al 2022).…”

“…The CNPA consists of a battery of tests administered by a trained psychometrist in a clinical setting, lasting approximately 2 hours long. The component tests of the CNPA evaluated 7 cognitive domains, described in full in (Grethlein et al 2022), and were selected for their sensitivity to detecting HAND (Carey et al 2004;de Almeida et al 2017). The presence or absence of HAND in PWH was confirmed via the Frasceteri criteria (Antinori et al 2007) using at least 2 psychometric measures per domain.…”

“…In our prior work (Grethlein et al 2022), a subset of virtual driving test (VDT) performance data that was most closely linked to the presence of HIV-associated neurocognitive disorders (HAND), a category of NCI that is specific to people with HIV (PWH), in a population of (n = 65) PWH study participants was isolated using feature selection. In this work, an additional (n = 19) HIV negative participants were recruited, (n = 7) of whom had non-HAND NCI (e.g., Parkinson's Disease, Alzheimer's, etc.…”