Driving Simulation Can Improve Insight into Impaired Driving Skills in Cirrhosis

• Published in: Digestive diseases and sciences 2012-02, Vol.57 (2), p.554-560
• Main Authors: Bajaj, Jasmohan S., Thacker, Leroy R., Heuman, Douglas M., Gibson, Douglas P., Sterling, Richard K., Todd Stravitz, R., Fuchs, Michael, Sanyal, Arun J., Wade, James B.
• Format: Article
• Language: English
• Subjects: Automobile Driving; Biochemistry; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Cognition Disorders - rehabilitation; Comparative analysis; Drunk driving; Female; Gastroenterology; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - etiology; Hepatology; Humans; Liver Cirrhosis - complications; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Psychometrics; Task Performance and Analysis; Transplant Surgery
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-011-1888-3

Background Minimal hepatic encephalopathy (MHE) is associated with poor driving skills and insight. Increasing insight may improve receptiveness for therapy or driving restrictions. Aim To evaluate the change in the self-assessment of driving skills (SADS) using a driving simulator. Methods Cirrhotic patients and age/education-matched controls underwent MHE testing with inhibitory control (ICT) and the psychometric hepatic encephalopathy score (PHES). SADS, a Likert scale from 0 to 10, was administered just before and after a standardized driving simulation comprising testing and navigation tasks. The percentage SADS change from baseline was compared within/between groups. Results A total of 84 patients (60% men, age 55 years) and 12 controls were included. Controls were significantly better than cirrhotics on cognitive/simulator testing. The baseline SADS was similar between the groups. The baseline patient SADS was only correlated with ICT lures ( r  = −0.4, P  = 0.001). Post-simulation, 60% of patients improved their insight, i.e., reduced SADS (from 8 to 6.5, P  = 0.0001) compared to 25% of controls ( P  = 0.02). The mean percentage SADS reduction was also higher in cirrhotics (18% vs. 8%, P  = 0.03). MHE on ICT patients had a significantly higher SADS improvement ( P  = 0.004) compared to the other patients; no difference was seen in those with/without MHE due to the PHES. The percentage SADS reduction in patients was correlated with getting lost ( r  = 0.468, P