Driving with HIV: Issues and Interventions
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The UC San Diego Antiviral Research Center conducts weekly presentations on current research and practices in infectious diseases, particularly HIV. This document focuses on a presentation about the impact of HIV on driving abilities, examining impairments in executive functioning and attention that may affect driving performance, and explores the potential benefits of processing speed training for individuals with HIV-associated neurocognitive disorders. The research aims to identify high-risk drivers and improve assessment protocols through advanced simulations and real-world evaluations.
Driving with HIV: Issues and Interventions
- 1. The UC San Diego AntiViral Research Center sponsors weekly presentations by infectious disease clinicians, physicians and researchers. The goal of these presentations is to provide the most current research, clinical practices and trends in HIV, HBV, HCV, TB and other infectious diseases of global significance. The slides from the AIDS Clinical Rounds presentation that you are about to view are intended for the educational purposes of our audience. They may not be used for other purposes without the presenter’s express permission. AIDS CLINICAL ROUNDS
- 2. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Driving and HIV: Issues and Interventions Thomas D. Marcotte, Ph.D. Associate Professor of Psychiatry UCSD School of Medicine www.hnrp.ucsd.edu
- 3. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Impairment before and after the introduction of Combination Antiretroviral Therapy Treatment 0% 10% 20% 30% 40% 50% 60% Asymptomatic Mildly symptomatic AIDS PercentImpaired Pre-CART CART Heaton et al., 2011
- 4. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Automobile Driving Perhaps the most complex and dangerous of everyday activities Driving requires intact attention, perception, tracking, choice reactions, sequential movements, judgment, and planning Critical for mobility in much of the U.S.; associated with self- identity and quality of life Cell-phones and infotainment technologies are ubiquitous, placing increasing demands on the driver
- 5. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Do HIV+ individuals demonstrate reduced driving abilities?
- 6. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO PC-based Driving Simulator
- 7. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Simulation #1: Advanced Routine and Emergency Driving 12 minute drive City and country driving Straight, curved, and inclined roads Speed limit ranged from 35 mph to 65 mph Subjects must pass cars, stop at traffic lights, drive around stalled vehicles, adjust to fog Accident avoidance: n=5 Primary outcome: Number of accidents
- 8. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Simulation #2: Virtual City
- 9. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO On-Road Driving Evaluation 30 minute evaluation modeled after the California DMV Driving Performance Evaluation (DPE) » Assesses: traffic checks speed control lane position merging dangerous maneuvers Residential, business sections; freeway driving; destination task Evaluation completed by driving rehabilitation instructor and trained research assistant
- 10. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO The Impact of HIV-Associated NP Impairment on Driving HIV+ NP Normal HIV+ NP ImpairedHIV-
- 11. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Can we predict unsafe on-road driving based upon laboratory assessments?
- 12. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO “Safe” vs. “Unsafe” Drivers
- 13. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Laboratory Predictors of On-Road Driving Performance Overall model p < .001 47.6% of on-road variance explained Marcotte et al., 2004 (Education and miles driven in past year differed between groups, but were not significant in the model (p > .30) and were dropped from the model) Impairments in Executive Functioning, Attention/Working Memory were the best predictors of on-road failure Variable p NP Global Deficit Score .017 Simulator Accidents .029 Virtual City Return Blocks .07
- 14. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Visual attention and driving performance in HIV Infection Marcotte et al., 2006
- 15. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Background Deficits in visual attention are believed to play a significant role in automobile accidents in many populations (e.g., the elderly)
- 16. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Background In driving research, visual attention is often assessed using the Useful Field of View (UFOV), a computerized measure of • Processing Speed • Divided Attention • Selective Attention
- 17. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Background UFOV performance has been associated with: » Past accident history in older adults (Ball et al., 1993; Sims et al., 2000) » Future accidents in older adults (Owsley et al., 1998) » Simulator performance (Rizzo et al., 1997) » On-road driving evaluations (Myers et al., 2000) UFOV declines in » Alzheimer disease (Duchek et al., 1998) » TBI patients (Rijn et al., 2002) » Multiple sclerosis (Schultheis et al., 2001; Schultheis et al., 2002)
- 18. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Useful Field of View (Owsley et al, 1998; Ball et al, 1993) Part I - Central Vision/Processing Speed » Identify target presented in center of screen for varying lengths of time Part II - Divided Attention » Identify target as in Part I, but also localize a simultaneously presented target object displayed in the periphery of the screen Part III - Selective Attention » Similar to Part II, but target object in the periphery is embedded in distractors
- 19. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Useful Field of View » Output is the threshold stimulus duration (ms) - the point at which the examinee correctly localizes the peripheral target 75% of the time » It is NOT a reaction time test; the outcome is the accuracy of the responses
- 20. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO UFOV Risk classification HIV- (n = 21) HIV+ (n = 43) Very Low 19 (90%) 25 (58%) Low 2 (10%) 7 (16%) Low to moderate -- 5 (12%) Moderate to high -- -- High - - Very high -- 6 (14%)
- 21. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Number of Accidents per Million Miles (past year)
- 22. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Clinic/Lab Real World Testing Environment » Most assessments attempts to elicit optimal performance to examine capacity • distractions/noise are minimized • complete one task at a time, limiting complexity and task length • with support from the examiner Real World » distractions are abundant » multi-tasking is the norm » directions/encouragement are often absent
- 23. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Can we improve upon current laboratory approaches to identifying individuals who might be at risk for poor automobile driving?
- 24. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Aims To examine EEG-based algorithms (e.g., distraction) during simulated and on-road driving To determine whether these algorithms improve prediction of impaired driving
- 25. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Assessing Brain Function in the Real World, in Real Time
- 26. Distraction
- 27. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Distraction Prior to Crash 0 0.05 0.1 0.15 0.2 0.25 0.3 -20 -19 -18 -17 -16 -15 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 IMPACT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Probability(EEG) Seconds Yellow – no crash; Purple - crash
- 28. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Average Distraction Crash By HIV Status 0 0.05 0.1 0.15 0.2 0.25 Control Crash Negative Positive
- 29. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Early Results Supports the feasibility of collecting wireless EEG data during dynamic simulator runs, and syncing algorithmic estimates of Distraction to simulator events, such as crashes Provides preliminary data supporting the potential utility of these methods in individuals with brain disorders Next steps: On-road application
- 30. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Aging and Driving-Related Performance
- 31. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Aging of the HIV Population
- 32. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Number of crashes per mile traveled by driver age, 2001-02 (Insurance Institute for Highway Safety)
- 33. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Aims Within a single non-patient, cognitively-normal cohort covering a large age span, to determine 1. Which specific components of driving related ability declined with age 2. Whether laboratory-based driving simulations measuring diverse components of driving could identify individuals with on-road driving deficits
- 34. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Demographics (HIV seronegative) < 50 y.o (n = 14) 50-70 y.o. (n = 13) > 70 y.o. (n = 11) p Age 33.5 (9.4) 62.1 (5.8) 77.7 (4.1) .001 Education (years) 14.6 (1.5) 14.6 (2.6) 14.0 (2.6) .75 Gender (% male) 71% 92% 45% .03 Miles/past year 8,275 4,535 3,437 .21
- 35. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Simulator Errors by Age
- 36. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Divided Attention/Lane Tracking Simulator task Maintain speed, lane position, and respond to divided attention tasks Steering variability Divided attention task » Response time » Accuracy
- 37. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Performance on Lane Tracking Simulation 1.1 1.21.2 2 1.1 4.1 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 Swerving Speed Deviation <50 50-70 70+ 14 50 91 0 10 20 30 40 50 60 70 80 90 100 % Missed DA <50 50-70 70+ NS * *
- 38. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Percent with Marginal or Worse On-Road Driving Evaluation
- 39. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Predictors of On-Road Performance Across the Lifespan • Initial Model • Selective Attention from the UFOV • Response time deviation from the Divided Attention/Lane Tracking test • Age • Mileage in the past year • Response time deviation was the only significant factor (R2 = .395, p = .0002) • An ROC analyses using response time variability identified a cutpoint yielding: • Sensitivity = 89.9% • Specificity = 84.4%
- 40. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO American Academy of Neurology: Recommendations for indentifying dementia patients at risk for unsafe driving Useful characteristics: » Clinical Dementia Rating Scale (LEVEL A) » Caregiver’s rating of patient’s driving ability (LEVEL B) » History of accidents or traffic violations (LEVEL C) » Self-reported avoidance or significant reduction of driving (LEVEL C) » Mini-Mental State Examination score below 24 (LEVEL C) » Aggressive or impulsive personality characteristics (LEVEL C) Insignificant characteristics: » Self-ratings of safe driving ability (LEVEL A) » Lack of situational driving avoidance (LEVEL C) Iverson,MD, D. J. et al. (2010) A – Established effective; B – Probably; C - Possibly
- 41. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Driving Assessment Questions 1. Traffic tickets or warnings, or accidents/“fender benders” in past two years? 2. Hit curbs or other objects (fence, garage) more than used to? 3. More “near misses” or “close calls” lately? 4. Missing turns or responding slower to road signs recently? 5. Get lost? 6. More difficulty driving when following directions? 7. Others express concern about driving ability? 8. Others avoid riding in the car? 9. Feel nervous about driving at night, making left turns into oncoming traffic or driving in unfamiliar places? 10. Reduced driving mileage lately? 11. Pedestrians or cars “appear out of nowhere”? 12. Responding slower to unexpected situations? 13. “Honked” at while driving? 14. Distracted or have trouble concentrating while driving? 15. Lost confidence in driving ability? Adapted from Eby et al. (2000) and Wang et al. (2003)
- 42. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Remediation of HAND: Initial efficacy, real-world relevance, and mechanisms Pilot Intervention Research Grant (R34) to be funded by the National Institute of Mental Health
- 43. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Processing Speed (PS) Training PS training in older adults suggest considerable neural plasticity Short training protocols (approximately 10 weeks) show improved performance in cognitive tasks and time-based laboratory measures of everyday functioning Strongest effects are seen in adults who demonstrate PS impairment Less on-road dangerous driving persisting over an 18 month period
- 44. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO PS Training in HIV Infection (Vance et al., 2012) HIV+ participants improved on Useful Field of View and Timed Instrumental Activities of Daily Living after receiving PS training Suggests that there may be benefits to PS training in HIV- infected individuals
- 45. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Aims 1. To develop a protocol for, and determine the feasibility of, implementing a visual processing speed (PS) training program for individuals with HIV-Associated Neurocognitive Disorders (HAND) 2. To determine whether PS training improves performance on » standardized cognitive measures » previously validated laboratory measures of everyday functioning (driving, multi-tasking) 3. To determine whether PS training alters visual scanning behavior and improves performance in the context of in-vehicle multitasking
- 46. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Remediation of HAND: Protocol HIV+ with PS deficits (n = 50) TREATMENT PositScience “Insight” (home or lab) CONTROL Computer games/tasks Randomization 8 weeks (16 sessions) R E - A S S E S S 6 Mo A S S E S S NP/EDF Assess Assessments: Driving Simulator Eye tracking Multi-tasking: Cooking, finances, meds, phone Useful Field of View Digit Vigilance Color Trails
- 47. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Intervention Uses adaptive tracking methods to continuously adjust a dimension of the task to the sensory and cognitive abilities of the participant Exercises rapidly adjust to individual’s performance levels and maintain an optimal level of difficulty for efficient learning Approach typically locks individual’s performance at 80- 90% correct
- 48. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Interventions BIRD SAFARI Task: identify bird from a group of similar birds in a circle around periphery Goal: improve ability of visual system to rapidly identify salient objects in periphery visual field. JEWEL DIVER Task: track several hidden jewels as they move around the screen Goal: improve ability of visual system to continuously track multiple objects against a field of distractors; divided attention
- 49. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Interventions MASTER GARDENER Task: quickly scan images in different positions and correctly identify matching images Goal: improve ability of visual system to make rapid eye movements, process relevant information and make rapid correct decisions; visual working memory ROAD TOUR Task: identify the correct car from central view and correct position of sign in useful field of view. Goal: expand the spatial area over which visual system can rapidly identify and localize objects with divided attention; expand UFOV
- 50. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Interventions SWEEP SEEKER Task: watch frequency sweeps an identify the direction of movement (inward or outward) Goal: improve processing speed and ability to respond to successively presented stimuli
- 51. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Cell Phones/Infotainment and Driving • When the task is boring and uneventful, we tend to seek out stimulation (change radio stations, talk on phone)
- 52. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Surrogate Reference Task (SURT)
- 53. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Remediation of HAND: Initial efficacy, real-world relevance, and mechanisms Goal is to provide preliminary evidence regarding the feasibility and possible efficacy and mechanisms of improving PS-related deficits at a time when HIV- associated cognitive disorders appear unresolvable via pharmaceutical treatments alone
- 54. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Summary Mild cognitive impairments negatively impact driving performance In a subset of impaired individuals, the reduction in driving performance may put them at increased risk for accidents Attentional deficits are common and may affect specific aspects of driving There is evidence regarding the validity of simulators and other novel approaches in predicting on-road driving performance Aging may pose an increased risk of impaired driving in HIV populations Interventions may prove useful in remediating HIV-related driving deficits
- 55. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Acknowledgements Neuropsychology » Robert Heaton, PhD » Igor Grant, MD » Steven P. Woods, PsyD Neurology/Medicine » Ron Ellis, MD, PhD » Scott Letendre, MD » J. Allen McCutchan, MD Research Coordinators » Terence Hendrix » Rachel Meyer » Heather Bentley » Erica Roberts HNRC Statisticians » Reena Deutsch, PhD » Anya Umlauf, MS » Tanya Wolfson, MS Doctoral Students » J. Cobb Scott » Rujvi Kamat Student Volunteers » Stephanie Zapata » Victoria O’Carroll HNRC Data Management » Clint Cushman » Joey Mendex » Chip Servin Systems Technology, Inc » Ted Rosenthal » Wade Allen
- 56. Driving in India “Good brakes, good horn, good luck”
- 57. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Driving and HIV: Issues and Interventions Thomas D. Marcotte, Ph.D. Associate Professor of Psychiatry UCSD School of Medicine tmarcotte@ucsd.edu www.hnrp.ucsd.edu
- 58. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO California Health and Safety Code 103900 “Every physician and surgeon shall report immediately to the local health officer in writing, the name, date of birth, and address of every patient at least 14 years of age or older whom the physician and surgeon has diagnosed as having a case of a disorder characterized by lapses of consciousness. However, if a physician and surgeon reasonably and in good faith believes that the reporting of a patient will serve the public interest, he or she may report a patient's condition even if it may not be required under the department's definition of disorders characterized by lapses of consciousness pursuant to subdivision”
- 59. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO Physicians reporting HIV driving impairment California Medical Association supports the policy to not report HIV positive patient by name, rather track the disease with unique codes to keep confidentiality While not mandatory to report HIV patients to the DMV, physicians should report “medical conditions that may impair ability to operate a motor vehicle safely to local health officer” Good Faith Discretionary Report- A physician can report a patient if “they reasonably and in good faith believe that it will serve the public interest” A physician who makes either a good faith discretionary report or a mandatory report are not held liable California Medical Association; www.cmanet.org
- 60. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGOHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO AAN Guidelines for Dementia