title: Preliminary observations on MRI correlates of driving independence and performance in persons with heart failure.
abstract: OBJECTIVE
  Heart failure patients often require assistance with activities of daily living, including driving. Recent work shows heart failure patients commit more errors on a simulated driving task relative to controls and cognitive dysfunction contributed to these errors. We sought to extend these findings by examining whether structural magnetic resonance imaging indices correlate with driving independence and performance in heart failure.
  
  
  METHODS
  Forty-nine heart failure patients underwent brain magnetic resonance imaging and performed a battery assessing attention/executive function and memory. A self-report instrument was used to assess independence in transportation. A subset of heart failure participants (N = 8) completed a validated driving simulator scenario.
  
  
  RESULTS
  Among the larger sample (N = 49), reduced gray matter correlated with greater dependence in transportation and worse attention/executive function; in turn, worse attention/executive function predicted greater assistance with transportation (p < 0.05). Among the subset that completed the driving simulator (N = 8), reduced gray matter correlated with more stop signs missed and increased white matter hyperintensities correlated with greater collisions, centerline crossings and time out of lane (p < 0.05). Poorer attention/executive function was also associated with more time over the speed limit on the driving simulation (p < 0.05). Follow-up analyses showed the above effects were largely independent of age.
  
  
  CONCLUSIONS
  Reduced structural brain integrity is associated with poorer reported and simulated driving in persons with heart failure. Larger prospective studies that employ on-road testing are needed to clarify brain changes and risk for unsafe driving in heart failure.
authors.affiliation: 1Department of Psychology, Kent State University, Kent, OH, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Alosco
authors.forename: Marc S
authors.initials: MS
authors.lastname: Penn
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Spitznagel
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Cleveland
authors.forename: Erica Y
authors.initials: EY
authors.lastname: Griffith
authors.forename: Atul
authors.initials: A
authors.lastname: Narkhede
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001288:Attention / Q000502:physiology; D001334:Automobile Driving; D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000502:physiology*; D057566:Self Report; D013223:Statistics as Topic
keywords: cognitive function; driving simulation; heart failure; neuroimaging; transportation