Very little is known about the use of simulated driving to assess neurological impairment in the setting of liver disease. The specific aim this pilot study was to determine if a computerized driving routine could identify individuals judged to be impaired by neuropsychological testing from a population of cirrhotic patients awaiting liver transplantation. Driving performance of cirrhotic patients awaiting liver healthy volunteers (n=31) was compared in a preliminary evaluation of theatients also underwent six cognitive domains (attention, learning, emory, motor, processing speed, visual); impairment of each domain was defined by a Z-score < -1. Thirteen of fifteen cirrhotics were classified as impaired in at least one cognitive domain based on neuropsychological testing. Driving performance of impaired cirrhotics differed significantly from the cohort of non-impaired plus healthy subjects (n=33). Several driving variables showed a strong correlation with impairment of at least one cognitive domain. In contrast, driving performance could not be predicted from MELD score in this population of cirrhotic patients. A computer-simulated driving system such as HEADS may prove useful as a simple and practical means to assess cognitive impairment from liver disease. Further validation is indicated in a larger study population of cirrhotic patients.(Author/publisher).
Samenvatting