Jacobs Milou, Hart Ellen P, Miranda Yuri Mejia, Groeneveld Geert Jan, van Gerven Joop M A, Roos Raymund A C
a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands.
b Centre for Human Drug Research , Leiden , The Netherlands.
Traffic Inj Prev. 2018;19(7):708-714. doi: 10.1080/15389588.2018.1497796. Epub 2018 Oct 1.
In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments.
This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups.
Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway.
Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD.
在临床实践中，亨廷顿舞蹈症（HD）患者常常决定只在自己熟悉的社区内驾驶，而不在高速公路或陌生区域驾驶。本研究的目的是确定HD基因携带者与健康个体在模拟城市和高速公路环境下驾驶表现的差异。
这项横断面研究纳入了87名参与者（28名症状前HD患者、30名症状期HD患者、29名对照者）。所有参与者均为现役驾驶员，通过驾驶模拟器、驾驶史问卷和统一亨廷顿舞蹈症评定量表进行评估。驾驶模拟器测试包括城市和高速公路场景。采用方差分析和Kruskal-Wallis检验对所有3组在城市和高速公路上的驾驶情况进行比较。
在限速提高（80和100公里/小时）时，症状期HD患者比对照者和症状前HD患者驾驶速度更慢，在高速公路和30公里/小时限速区域内，其速度稳定性也不如症状前HD患者。在高速公路上，与对照者和症状前HD患者相比，症状期HD患者横向位置的标准差也更大（即车辆摆动更多/车辆控制能力更弱）。
与症状前HD患者和对照者相比，症状期HD患者在驾驶模拟器中限速提高时驾驶更为谨慎，在高速公路上对车辆的控制能力也较弱。驾驶模拟器参数能够区分症状期HD患者和健康个体，因此驾驶模拟器似乎是研究症状期HD患者驾驶变化时的一种可行工具。
