Visual Attention Deficits are Associated with Driving Accidents in Cognitively-Impaired HIV-Infected Individuals

Abstract

Previous research has found HIV-associated neuropsychological (NP) dysfunction to be associated with impaired driving skills. To determine whether specific impairments in visual attention impart an increased accident risk, we assessed 21 HIV seronegative (HIV-) and 42 seropositive (HIV+) participants on NP tests and the Useful Field of View (UFOV), a computerized test of visual attention. HIV+ participants performed significantly worse than the HIV- participants on the UFOV, particularly on the Divided Attention subtest. Poor UFOV performance was associated with higher accident rates in the past year, with a trend for NP impairment to also predict more accidents. The highest number of accidents occurred in the group with a "high risk" UFOV designation and NP impairment; this category correctly classified 93% of HIV+ participants as to who did, and did not, have an accident. Clinicians should attend to visual attention as well as general cognitive status in estimating which patients are at risk for impaired driving.

The Neuropsychology of HIV/AIDS in Older Adults

“…Related to this issue of impaired attention deficits in older HIV-positive adults is the operation of complex attention-demanding systems such as driving a car. For instance, it has been shown in HIV-positive adults that impairment in attention, executive functioning, speed of information processing, and motor abilities is associated with decreased driving ability (Marcotte et al 1999;Marcotte et al 2006;Marcotte et al 2004). Although no data on driving ability exists to date specifically in older HIV-positive adults, the preliminary results from the Hardy et al (2004) study cited in this review suggest that these older adults may be at risk for impairment in demanding complex scenarios such as driving a car, flying aircraft, and so on.…”

Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China

“…It is unclear whether NP impairment still produces worse medical outcomes in the context of HAART, but there is considerable evidence that even mild NP impairment is associated with reduced vocational functioning and other difficulties with cognitive aspects of everyday functioning: medication management, driving, and Instrumental Activities of Daily Living (IADLs; Carter et al, 2003;Heaton et al, 2004a;Hinkin et al, 2004;Marcotte et al, 2006). It is unknown whether any NP deficits that may be observed among HIV infected Chinese farmers would have the same relevance in their lives, or if such deficits could even be noticed by the patients and others around them.…”

Meeting Practical Challenges of a Trial Involving a Multitude of Treatment Regimens: An Example of a Multi-Center Randomized Controlled Clinical Trial in NeuroAIDS

“…This approach classifies antiretrovirals into three categories determined by their estimated penetration characteristics. Details of the scoring scheme are described elsewhere (Letendre et al 2006, submitted for publication). Briefly, information incorporated into the scheme includes drug-specific antiretroviral chemical properties, CSF concentrations (absolute, relative to plasma concentrations, and relative to drug-specific population IC 50 ), and clinical studies of CSF virologic suppression and neurocognitive improvement.…”

“…Thus, HNCI is a significant burden to persons living with HIV infection, caregivers, and the health care system. Compared to cognitively intact HIV+ persons, impaired HIV+ individuals have a lower quality of life (Kaplan et al 1995), are more likely to be unemployed (Heaton et al 1994;Albert et al 1995;van Gorp et al 1999), and have greater difficulty with vocational functioning (Heaton et al 1996), medication management (Albert et al 1999;Hinkin et al 2002;Heaton et al 2004), driving an automobile (Marcotte et al 1999(Marcotte et al , 2006, and other activities of daily living (ADLs) , and a higher risk of death (Ellis et al 1997).…”