title: A multimodal assessment of driving performance in HIV infection.
abstract: OBJECTIVE
  To examine if HIV-seropositive (HIV+) individuals are at risk for impaired driving.
  
  
  METHODS
  Sixty licensed drivers (40 HIV+, 20 HIV-) completed a neuropsychological (NP) test battery and driving assessments. Eleven HIV+ subjects were NP-impaired. Driving-related skills were assessed using 1) two driving simulations (examining accident avoidance and navigational abilities), 2) the Useful Field of View (UFOV) test, and 3) an on-road evaluation.
  
  
  RESULTS
  HIV+ NP-impaired subjects had greater difficulty than cognitively intact subjects on all driving measures, whereas the HIV- and HIV+ NP-normal groups performed similarly. On the UFOV, the HIV+ NP-impaired group had worse performance on Visual Processing and Divided Attention tasks but not in overall risk classification. They also had a higher number of simulator accidents (1.3 vs 2.0; p = 0.03), were less efficient at completing the navigation task (3.2 vs 9.2 blocks; p = 0.001), and were more likely to fail the on-road evaluation (6 vs 36%; p = 0.02). Impairment in Executive Functioning was the strongest NP predictor of failing the on-road drive test. NP performance and both simulations independently contributed to a model predicting 48% of the variance in on-road performance.
  
  
  CONCLUSIONS
  HIV+ NP-impaired individuals are at increased risk for on-road driving impairments, whereas HIV+ individuals with normal cognition are not at a significantly higher risk than HIV- subjects. Executive Functioning is most strongly associated with impaired on-road performance. Cognitive and simulator testing may each provide data in identifying driving-impaired individuals.
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA, USA. tmarcotte@ucsd.edu
authors.forename: T D
authors.initials: TD
authors.lastname: Marcotte
authors.forename: T
authors.initials: T
authors.lastname: Wolfson
authors.forename: T J
authors.initials: TJ
authors.lastname: Rosenthal
authors.forename: R K
authors.initials: RK
authors.lastname: Heaton
authors.forename: R
authors.initials: R
authors.lastname: Gonzalez
authors.forename: R J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: I
authors.initials: I
authors.lastname: Grant
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology*; D000063:Accidents, Traffic / Q000517:prevention & control / Q000523:psychology; D000328:Adult; D001334:Automobile Driving / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards*; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D011597:Psychomotor Performance / Q000502:physiology; D012307:Risk Factors; D014584:User-Computer Interface