Visual Attention Deficits are Associated with Driving Accidents in Cognitively-Impaired HIV-Infected Individuals

Abstract

Previous research has found HIV-associated neuropsychological (NP) dysfunction to be associated with impaired driving skills. To determine whether specific impairments in visual attention impart an increased accident risk, we assessed 21 HIV seronegative (HIV-) and 42 seropositive (HIV+) participants on NP tests and the Useful Field of View (UFOV), a computerized test of visual attention. HIV+ participants performed significantly worse than the HIV- participants on the UFOV, particularly on the Divided Attention subtest. Poor UFOV performance was associated with higher accident rates in the past year, with a trend for NP impairment to also predict more accidents. The highest number of accidents occurred in the group with a “high risk” UFOV designation and NP impairment; this category correctly classified 93% of HIV+ participants as to who did, and did not, have an accident. Clinicians should attend to visual attention as well as general cognitive status in estimating which patients are at risk for impaired driving.

Acknowledgments

This study was supported by awards MH 57593 and MH 62512 from the National Institute of Mental Health, and a research grant from the University of California Academic Senate.

Portions of this study were presented at the 32nd Annual Meeting of the International Neuropsychological Society, February 4–7, 2004, Baltimore, MD.

*The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the San Diego Veterans Affairs Healthcare System, and includes: Director: Igor Grant, M.D.; Co-Directors: J. Hampton Atkinson, M.D. and J. Allen McCutchan, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Naval Hospital San Diego: Mark R. Wallace, M.D. (P.I.); Neuromedical Component: J. Allen McCutchan, M.D. (P.I.), Ronald J. Ellis, M.D., Scott Letendre, M.D., Rachel Schrier, Ph.D.; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), Mariana Cherner, Ph.D., Julie Rippeth, Ph.D., Joseph Sadek, Ph.D., Steven Paul Woods, Psy.D.; Imaging Component: Terry Jernigan, Ph.D. (P.I.), John Hesselink, M.D., Michael J. Taylor, Ph.D.; Neuropathology Component: Eliezer Masliah, M.D. (P.I.), Dianne Langford, Ph.D.; Clinical Trials Component: J. Allen McCutchan, M.D., J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., Scott Letendre, M.D.; Data Management Unit: Daniel R. Masys, M.D. (P.I.), Michelle Frybarger, B.A. (Data Systems Manager); Statistics Unit: Ian Abramson, Ph.D. (P.I.), Deborah Lazzaretto, M.A.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government

Notes

^aValues are for participants with detectable HIV RNA.

^bMedian (interquartile range).

^amedian, interquartile range (IQR).

^bPermutation test (see Statistical Analyses section).

^cFisher's Exact Test.

^aPermutation test.

^bWilcoxon rank sum test.

^aWilcoxon rank sum test.

^bPermutation test.