Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathy
Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathy
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DOI：
10.1002/hep.22032
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发表时间：
2008-02-01
期刊：
影响因子：
13.5
通讯作者：
Saeian, Kia
中科院分区：
文献类型：
--
作者：
Bajaj, Jasmohan S.;Hafeezullah, Muhammad;Saeian, Kia
轻度肝性脑病（MHE）患者存在注意力、反应抑制和工作记忆困难，这些困难与驾驶障碍和高机动车事故风险相关。导航是一个复杂的系统，需要安全驾驶，需要功能的工作记忆和其他领域的不利影响MHE本研究的目的是确定MHE对导航skiffs的影响，并将其与心理测量障碍。49例非酒精性肝硬化患者（34例MHE+，15例MHE-;根据组块设计、数字符号和数字连接测试A进行分组）和48例年龄/教育匹配的对照者被纳入研究。所有患者均接受心理测量成套测验、抑制控制测验（ICT）和驾驶模拟测验。驾驶模拟包括4个部分：（1）训练;（2）驾驶（结果是事故）;（3）分散注意力（结果是错过任务）;（4）导航，在“虚拟城市”中沿地图上标记的路径沿着驾驶（结果是非法转弯）。与MHE-/对照组（中位数为0）相比，MHE+组（中位数为1; P = 0.007）的非法转弯显著更高。与其他患者相比，MHE+患者错过了更多的分散注意力任务（中位数MHE+ 1，MERE-/对照组0; P = 0.001）。同样，与MHE-（中位数1）或对照组（中位数2）相比，MHE+患者（中位数2.5; P = 0.004）的事故发生率更高。事故与违规转弯有显著相关性（P = 0.001，r = 0.51）。ICT损伤是与非法转弯（r = 0.6）和事故（r = 0.44）最相关的测试，尽管其他测试的损伤也与非法转弯相关。结论：MHE阳性患者在驾驶模拟器上的导航艇受损，这与反应抑制（ICT）和注意力的受损相关。这种导航困难可能会造成额外的驾驶问题，加剧了预先存在的注意力缺陷的有害影响。
Patients with minimal hepatic encephalopathy (MHE) have attention, response inhibition, and working memory difficulties that are associated with driving impairment and high motor vehicle accident risk. Navigation is a complex system needed for safe driving that requires functioning working memory and other domains adversely affected by MHE The aim of this study was to determine the effect of MHE on navigation skiffs and correlate them with psychometric impairment. Forty-nine nonalcoholic patients with cirrhosis (34 MHE+, 15 MEE-; divided on the basis of a battery of block design, digit symbol, and number connection test A) and 48 age/education-matched controls were included. All patients underwent the psychometric battery and inhibitory control test (ICT) (a test of response inhibition) and driving simulation. Driving simulation consisted of 4 parts: (1) training; (2) driving (outcome being accidents); (3) divided attention (outcome being missed tasks); and (4) navigation, driving along a marked path on a map in a "virtual city" (outcome being illegal turns). Illegal turns were significantly higher in MHE+ (median 1; P = 0.007) compared with MHE-/controls (median 0). Patients who were MHE+ missed more divided attention tasks compared with others (median MHE+ 1, MERE-/controls 0; P = 0.001). Similarly, accidents were higher in patients who were MHE+ (median 2.5; P = 0.004) compared with MHE- (median 1) or controls (median 2). Accidents and illegal turns were significantly correlated (P = 0.001, r = 0.51). ICT impairment was the test most correlated with illegal turns (r = 0.6) and accidents (r = 0.44), although impairment on the other tests were also correlated with illegal turns. Conclusion: Patients positive for MHE have impaired navigation skiffs on a driving simulator, which is correlated with impairment in response inhibition (ICT) and attention. This navigation difficulty may pose additional driving problems, compounding the pre-existing deleterious effect of attention deficits.