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Driving Simulation Can Improve Insight into Impaired Driving Skills in Cirrhosis

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Abstract

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 < 0.0001), crashes (P = 0.002), and centerline/road-edge excursions (P = 0.01). There was a significantly higher percentage SADS reduction in cirrhotics who got lost (25%) compared to those who did not get lost (12%) and controls (8%, P = 0.014).

Conclusions

Insight into driving skills in cirrhosis improves after driving simulation and is highest in those with navigation errors and MHE on ICT. Driving simulator-associated insight improvement may be the first step towards the cognitive rehabilitation of driving skills in cirrhosis.

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Acknowledgments

This study was partly supported by the American College of Gastroenterology (ACG) Junior Faculty Development Award, R01DK087913 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), and award UL1RR031990 from the National Center for Research Resources (NCRR), NIH.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA

    Jasmohan S. Bajaj, Douglas M. Heuman, Richard K. Sterling, R. Todd Stravitz, Michael Fuchs & Arun J. Sanyal

  2. Division of Psychology, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA

    Douglas P. Gibson & James B. Wade

  3. Division of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA

    Leroy R. Thacker

Authors
  1. Jasmohan S. Bajaj
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  3. Douglas M. Heuman
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  4. Douglas P. Gibson
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  7. Michael Fuchs
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  8. Arun J. Sanyal
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  9. James B. Wade
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Corresponding author

Correspondence to Jasmohan S. Bajaj.

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Bajaj, J.S., Thacker, L.R., Heuman, D.M. et al. Driving Simulation Can Improve Insight into Impaired Driving Skills in Cirrhosis. Dig Dis Sci 57, 554–560 (2012). https://doi.org/10.1007/s10620-011-1888-3

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  • DOI: https://doi.org/10.1007/s10620-011-1888-3

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