Driving Simulator Performance Research Articles

Effects of kratom on driving: Results from a cross-sectional survey, ecological momentary assessment, and pilot simulated driving Study

Objectives Despite widespread kratom use, there is a lack of knowledge regarding its effects on driving. We evaluated the self-reported driving behaviors of kratom consumers and assessed their simulated-driving performance after self-administering kratom products. Methods We present results from: 1) a remote, national study of US adults who regularly use kratom, and 2) an in-person substudy from which we re-recruited participants. In the national study (N = 357), participants completed a detailed survey and a 15-day ecological momentary assessment (EMA) that monitored naturalistic kratom use. For the remote study, outcomes were self-reported general and risky driving behaviors, perceived impairment, and driving confidence following kratom administration. For the in-person substudy, 10 adults consumed their typical kratom products and their driving performance on a high-fidelity driving simulator pre- and post-kratom administration was evaluated. Results Over 90% of participants surveyed self-reported driving under the influence of kratom. Most reported low rates of risky driving behavior and expressed high confidence in their driving ability after taking kratom. This was consistent with EMA findings: participants reported feeling confident in their driving ability and perceived little impairment within 15-180 min after using kratom. In the in-person substudy, there were no significant changes in simulated driving performance after taking kratom. Conclusions Using kratom before driving appears routine, however, self-reported and simulated driving findings suggest kratom effects at self-selected doses among regular kratom consumers do not produce significant changes in subjective and objective measures of driving impairment. Research is needed to objectively characterize kratom’s impact on driving in regular and infrequent consumers.

From fear to forecast: The role of simulators, accompanied driving, age, gender, and information-processing style in driver training and beyond

BackgroundEven though accompanied driving and simulator training are common, clarity on their usage trends and effectiveness is lacking. This research aimed to deepen the understanding of the relationships between personal characteristics, pre-licence accompanied driving, self-reported post-licence driving behaviour, and driving performance scores during simulator lessons. MethodsWe used data from a questionnaire completed by simulator and non-simulator students (total n = 3,761). Data were analysed by dividing the sample into two groups based on variables such as gender, age at licensure, education level, fear of driving a car when starting driver education, information-processing style, participation in accompanied driving, and the number of driving simulator lessons completed. ResultsMales took fewer on-road lessons and reported lower fear, but they had poorer simulator safety scores than females. Younger learners required fewer lessons and test attempts, were less fearful, and violated traffic rules more than older respondents. Higher-educated respondents had more fear and safer driving scores in the simulator. Thinkers, who were typically more educated, showed more caution in the simulator and on the road, and were older at licensure. Compared to regular students, students participating in accompanied driving were younger at licensure. Moreover, students with a higher driving skill score in the simulator were less fearful and needed slightly fewer attempts to pass the road driving test. Discussion and conclusionThe fear towards driving, which is strongly linked to personal characteristics, provides a logical explanation for the progression of students through driver education. Furthermore, this study illustrated the possibility of considering information-processing styles, education level, and driving simulator performance in driving education. However, in order to conclusively study the safety-effectiveness of accompanied driving and simulator training, further research in the form of a randomised controlled trial is necessary.

O072 Simple Vestibular-Occular Motor Assessment as a Predictor of Alertness State and Driving Impairment during Extended Wakefulness

Abstract Introduction Driver fatigue contributes to 2-16% of road crashes, highlighting the need for improved detection of at-risk drivers. We used a novel and brief test of vestibular ocular motor system (VOMS) assessed via virtual reality goggles to predict alertness state and driving simulator performance during 29hr extended wakefulness. Methods 49 individuals (Mean±SD Age, 32.6±12.9, 45% Males) undergone 9hr baseline sleep opportunity followed by ~29hrs extended wakefulness with five 60min driving assessments. Cluster analysis, combining steering deviation and number of crashes were used to split participants into groups of either poor vs good driving performance. VOMS assessment was conducted using virtual reality goggles approximately 10mins before and after each drive. Predictive importance of VOMs metrics were ranked using XGBoost machine learning model, which was then utilized to distinguish between poor vs good driving groups. Model performance was evaluated using a 5-fold cross-validation approach using ROC analysis. Results XGBoost machine learning ranked all 70 VOMS metrics on their importance in predicting driving performance group for each drive. Top 10 metrics from pre-drive VOMS test predicted both daytime driving (tests 1-3, AUC 0.8 [95%CI 0.64-0.93], p<0.001) and night-time driving (tests 4-5, AUC 0.78 [95%CI 0.6-0.95, p<0.001]). Post-driving VOMS assessments also predicted daytime (AUC 0.74 [95%CI 0.53-0.9, p<0.001] and night-time driving (AUC 0.76 [95%CI 0.52-0.94, p<0.001]). Conclusion VOMS assessment show promise as a short and effective assessment of sleepiness to predict driving failure. Future validation in independent samples, sleep disordered population and in-field on-road testing are needed to confirm these promising findings.

Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis

With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. ClinicalTrials.gov Identifier: NCT02849587.

Evaluation of driving fitness using driving simulators in patients with right-hemisphere damage: an unmatched case-control study

ABSTRACT Background Patients with right hemisphere damage (RHD) may exhibit mild unilateral spatial neglect (USN), which is difficult to detect in general assessments performed during driving rehabilitation. Objectives We compared driving simulator performance, practical driving performance, and neuropsychological test results between patients with RHD who were able and unable to return to driving to predict driving fitness based on driving simulator performance. Methods This unmatched case-control study included 29 patients with RHD who were able (return-to-driving group, n = 16) and unable (non-return-to-driving group, n = 13) to return to driving. Patient demographics, motor function, attention, driving simulator performance (participants’ reaction time and rate to green lamps appearing in any of the three displays and average lane position), and practical driving performance were compared between the groups. Receiver operating characteristic (ROC) analysis was performed to examine the predictive performance of driving fitness in reaction rate and paper-and-pencil tests. Results The non-return-to-driving group had a significantly lower reaction rate than the return-to-driving group (p = 0.027; 95% confidence interval [CI], 0–7; r = 0.407). No significant difference in reaction time or lane position in either the left or right lane during driving simulation was observed. ROC analysis of the reaction rate in the driving simulator task showed sensitivity of 0.692, specificity of 0.812, and area under the curve of 0.738 [95% CI, 0.541–0.935]. Conclusions Decreases in reaction rates during simulated driving assessments are associated with an inability to resume driving in patients with RHD. Such assessments may aid in predicting fitness for driving in these patients.

Can Three-Dimensional Multiple Object Tracking Training Be Used to Improve Simulated Driving Performance? A Pilot Study in Young and Older Adults

Driving ability has been shown to be dependent on perceptual-cognitive abilities such as visual attention and speed of processing. There is mixed evidence suggesting that training these abilities may improve aspects of driving performance. This preliminary study investigated the feasibility of training three-dimensional multiple object tracking (3D-MOT)—a dynamic, speeded tracking task soliciting selective, sustained and divided attention as well as speed of processing—to improve measures of simulated driving performance in older and younger adults. A sample of 20 young adults (23–33 years old) and 14 older adults (65–76 years old) were randomly assigned to either a 3D-MOT training group or an active control group trained on a perceptual discrimination task as well as 2048. Participants were tested on a driving scenario with skill-testing events previously identified as optimal for cross-sectional comparisons of driving ability. Results replicated previously identified differences in driving behaviour between age groups. A possible trend was observed for the 3D-MOT trained group, especially younger adults, to increase the distance at which they applied their maximum amount of braking in response to dangerous events. This measure was associated with less extreme braking during events, implying that these drivers may have been making more controlled stops. Limitations of sample size and task realism notwithstanding, the present experiment offers preliminary evidence that 3D-MOT training might transfer to driving performance through quicker detection of or reaction to dangerous events and provides a rationale for replication with a larger sample size.

Correlation between visuo-cognitive tests and simulator performance of commercial drivers in the United States

BackgroundDriving commercial vehicles requires intact visuo-cognitive skills. Approximately 13% of all fatal motor vehicle crashes in the United States involve commercial drivers. The ability to accurately predict risk factors for unsafe commercial driving is essential for public safety. Accurate prediction tools will advance the field of commercial driver science, provide policy guidance for driver testing and assist healthcare providers during testing. Prior studies have correlated clinical tools to roadway safety; translating these results to commercial drivers has not yet been done. ObjectiveThis study aimed to identify specific demographic, driving history and visuo-cognitive test results that correlate with driving simulator performance. Using the Cumulative Simulator Score (CSS) as a surrogate for driving ability, the objective was to correlate both sets of data (self-reported and visuo-cognitive testing) with the CSS to identify screening tools for unsafe driving in commercial drivers.Principal Results.Baseline assessments of 120 variables were collected from October 2020 to January 2022. Of the 31 participants, 3 were female and 28 were male with a mean age of 53 years. Average BMI was 32, blood pressure 136/84, 32 years of CDL driving experience, 36,500 annual CDL mileage, 11,000 annual personal mileage, 14 years of education, average number of medications: 2, average number of medical conditions: 2, six participants with personal and/or commercial crashes or tickets in past five years, MOCA 27/30, Trails B time 66 s, UFOV Speed of Processing 15 ms, Stroke Disease Severity Assessment pass rate 94 %.The Cumulative Simulator Score (CSS), correlated significantly with education (r = 0.42; p = 0.02), commercial driving experience (r = 0.42; 0 = 0.02), and number of tickets as a commercial driver (Spearman rho = 0.40; p = 0.02). In a stepwise multivariable linear regression analysis, the number of tickets as a CDL driver in the past five years and years of education were retained as significant variables in the multivariable linear regression model, explaining 38 % of the variance of total scores on the CSS.Major Conclusions.Descriptive and self-reported driving characteristics correlate better with the Cumulative Simulator Score in CDL drivers than visuo-cognitive tests. Since simulator performance has been shown to be a reliable surrogate for driving performance, the number of tickets as a CDL driver in the past five years and years of education can be considered as additions to annual physicals for policy makers and health care providers to help assess their on-the-road safety.

Corrigendum for Aishah et al., vol. 130, 2021, p. 1373–1382

CorrigendumCorrigendum for Aishah et al., vol. 130, 2021, p. 1373–1382Published Online:25 Dec 2022https://doi.org/10.1152/japplphysiol.01074.2020_COROriginal articleMoreSectionsPDF (107 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Aishah A, Lim R, Sands SA, Taranto-Montemurro L, Wellman A, Carberry JC, Eckert DJ. Different antimuscarinics when combined with atomoxetine have differential effects on obstructive sleep apnea severity. J Appl Physiol (1985) 130: 1373–1382, 2021. First published March 18, 2021. doi: 10.1152/japplphysiol.01074.2020.The placebo and P values for diastolic data points in Table 4 were incorrect as originally published. The comparison remains nonsignificant, and the authors assert that the correction does not affect the results of the study. The corrected Table 4 appears below.Table 4. Effect of the drug combinations on next-morning driving simulator performance, blood pressure, and neck circumference compared with placeboAto-SolPAto-BipPPlaceboSteering deviation from median of lane, cm56.9 ± 29.30.2457.4 ± 31.10.2449.6 ± 25.0Speeding deviation from 60 to 80 km/h, km/h4.3 ± 6.40.503.9 ± 6.40.504.6 ± 7.6Individuals that crashed, %201.00201.0020Breaking reaction time, ms950 ± 1000.78920 ± 1000.781,000 ± 300Systolic, mmHg136 ± 19.20.77133 ± 18.80.77133 ± 14.5Diastolic, mmHg89.8 ± 15.20.2885.5 ± 13.80.2887.9 ± 12.0Neck circumference, cm40.9 ± 3.50.0640.8 ± 4.10.0642.4 ± 3.1Data are means ± SD. Pairwise comparisons were performed using the Student–Newman–Keuls method or Wilcoxon signed-rank test. *P < 0.05 (driving stimulator task n = 6, neck circumference n = 7). Ato-Bip, atomoxetine plus biperiden hydrochloride; Ato-Sol, atomoxetine plus solifenacin succinate. Boldface indicates data that have been corrected from the original version.This article has no references to display. Download PDF Previous Back to Top FiguresReferencesRelatedInformation Collections Related ArticlesDifferent antimuscarinics when combined with atomoxetine have differential effects on obstructive sleep apnea severity 02 May 2021Journal of Applied Physiology More from this issue > Volume 134Issue 1January 2023Pages 84-84 Crossmark Copyright & PermissionsCopyright © 2023 the American Physiological Society.https://doi.org/10.1152/japplphysiol.01074.2020_CORPubMed36566446History Published online 25 December 2022 Published in print 1 January 2023 Metrics

O068 Slow frequency wake EEG and hypoxemia during sleep predicts vigilance performance following extended wakefulness in patients with OSA

Abstract Study Objectives Obstructive sleep apnea is highly prevalent, but heterogeneous making identifying patients at risk of driving impairment challenging. Resting wake electroencephalography (qEEG) is associated with vigilance performance in healthy subjects. We examined if qEEG and clinical measures predict vigilance impairment in OSA. Methods Fifty-four patients underwent baseline PSG and 28hr extended wakefulness (EW) with 2 hourly psychomotor vigilance test (PVT) and Karolinska drowsiness test and driving simulator performance at baseline and following EW. Resting wake EEG was subjected to fast Fourier transform analysis to derive EEG power in delta, theta, alpha and beta ranges. Cluster analysis assigned participants into groups of either resistant (n=39) or vulnerable (n=15) to alertness failure based on PVT and driving performance. Backward stepwise regression models were used to determine the strongest clincal and wake EEG predictors vigilance impairment. Results Compared with resistant patients, the vulnerable group exhibited increased wake EEG delta (p&amp;lt;0.001) and theta (p=0.003) power during eyes open across all testing periods. The only significant predictors of vulnerability to alertness failure (PVT and driving) included O2Nadir from baseline PSG and baseline wake EEG theta and delta (eyes open) respectively explaining 42 and 32% of the variance in vigilance outcome in models that included Age, BMI, ESS, SOL, TST, AHI, O2 Nadir. Conclusions Slow frequency wake EEG (delta and theta) and hypoxemia are predictive of future alertness failure and driving impairments in patients with OSA. These findings are important for fitness to drive assessment in OSA but require validation in independent sample.

Do Impulse Control Disorders Impair Car Driving Performance in Patients with Parkinson's Disease?

Based on data regarding the prevalence of Parkinson's disease (PD), the prevalence of impulsive control disorders (ICD) in PD, and the percentage of PD patients driving a car, it has to be assumed that at least 50,000 PD patients with ICD in Germany actively drive a car. However, these patients might be at risk for unsafe driving due to ICD-related dysfunctions such as failure to resist an impulse or temptation, to control an act or other altered neurobehavioral processes. This study determines the influence of ICD on driving ability in PD. We prospectively compared driving simulator performance of 23 PD patients with and 23 matched patients without ICD. ICD had to be socially compensated and presence was defined clinically for primary and questionnaire-based (QUIP-RS) for post-hoc analyses. Furthermore, between-group comparisons of driving-relevant neuropsychological tests were executed. Except from a lower blinking frequency when changing lanes, overall driving safety of patients with ICD did not differ significantly from those without-regardless of the clinical or QUIP-RS-based ICD definition. ICD severity did not correlate with driving performance, but the latter correlated significantly with mean reaction times and certain neuropsychiatric tests (MoCA, TMT-A, TAP-M "flexibility" and DBQ "error"). Clinically compensated ICD does not seem to impair driving safety in PD patients. Rather, cognitive and attentional deficits appear to be clinical markers for driving uncertainty.

Feasibility of utilizing clinical and driving simulator assessments to indicate driving performance deficits in adults with multiple sclerosis

BACKGROUND: Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment that impact on-road driving performance. OBJECTIVE: This study examines the feasibility of utilizing visual-cognitive and driving simulator assessments to indicate driving performance deficits (operational, tactical, and strategic maneuvers) in drivers with MS. METHODS: Through an evidence-informed feasibility framework, we evaluated recruitment capability and resulting sample characteristics, data collection procedures and outcome measures, participants’ acceptability and suitability of the driving simulator, the resources and ability to implement the study, and clinical and driving simulator assessment results. RESULTS: Thirty-eight persons with MS (median age = 43 years, IQR = 19) and 21 persons without MS (median age = 41 years, IQR = 14) participated. Missing data on the driving simulator resulted from scenario complexity (13 with MS, 4 without MS) or the onset of simulator sickness (1 with MS, 1 without MS). Seven participants with MS and two participants without MS reported symptoms of simulator sickness. Participants with MS (vs without MS) made more adjustment to stimuli errors (tactical maneuvers). For participants with MS, immediate verbal/auditory recall or divided/selective attention correlated with simulated driving maneuvers. CONCLUSIONS: Study findings identified challenges (missing data, simulator sickness), but established feasibility for executing a full-scale study to predict driving simulator performance in drivers with MS.

Substance-use simulation impairs driving capability in patients with cirrhosis regardless of hepatic encephalopathy.

Driving is independently affected by cirrhosis and hepatic encephalopathy (HE) and alcohol/substance use, but their concomitant impact is unclear. We aimed to determine the impact of alcohol and other substances on driving‐simulator performance in cirrhosis with and without HE. Outpatients with cirrhosis and controls underwent cognitive testing and driving simulation for the following three conditions: baseline, wearing goggles simulating alcohol intoxication, and wearing goggles simulating opioid/benzodiazepine abuse. Outcomes were number of centerline crossings (CCs) and road‐edge excursions (REEs). We compared controls versus patients with cirrhosis then subjects with cirrhosis with and without HE for all conditions, using generalized linear modeling (GLM). Sixty subjects (17 controls, 43 with cirrhosis [Model for End‐Stage Liver Disease score, 10; 21 subjects with prior HE]) were included. Simulations showed higher CCs and REEs at baseline in patients with cirrhosis with and without HE versus controls. With alcohol‐ and substance abuse‐impairment goggles, CCs increased but REEs decreased in cirrhosis. In the GLM, a time and group interaction was seen (p < 0.001) for CCs and REEs. Patients with cirrhosis showed higher CCs and REEs at baseline than controls (CCs, p = 0.003; REEs, p = 0.0001) and higher CCs (p = 0.03) and lower REEs (p = 0.001) with alcohol‐simulating goggles. All groups were equally impaired with opioid/benzodiazepine‐simulating goggles (CCs, p = 0.49; REEs, p = 0.46). Controls with alcohol‐simulating goggles had similar CCs as the baseline of patients with cirrhosis (p = 0.98). conclusions: Simulating alcohol intake induces greater driving impairment in patients with cirrhosis versus controls, but similar patterns were seen with opioid/benzodiazepine‐simulating goggles. At baseline, patients with cirrhosis have simulator outcomes equivalent to intoxicated controls. Driving simulation with goggles modeling substance abuse could improve insight into driving errors and enhance driving rehabilitation in patients with cirrhosis.

Analysis of Remote Driving Simulation Performance for Low-speed Mobile Robot under V2N Network Delay Environment

Analysis of Remote Driving Simulation Performance for Low-speed Mobile Robot under V2N Network Delay Environment

Driving simulator performance worsens after the Spring transition to Daylight Saving Time

SummaryCircadian desynchrony and sleep deprivation related to the Spring transition to Daylight Saving Time (DST) have been associated with several unfavorable outcomes, including an increase in road traffic accidents. As previous work has mainly focused on analyzing historical crash/hospitalization data, there is virtually no literature investigating the effects of DST on specific driving performance indicators. Here, the effect of the Spring transition to DST on driving performance was investigated by means of a driving simulator experiment, in which participants completed two trials (one week distance, same time and day of the week) on exactly the same simulated route, the second trial taking place in the week after the transition to DST. Results were compared to those of a control group (who also underwent two trials, both before the DST transition), and documented significant worsening of driving performance after DST, as measured by a comprehensive set of simulator-derived indices.

The Effects of Visual Field Loss from Optic Disc Drusen on Performance in a Driving Simulator

ABSTRACT The purpose of this study was to compare the driving simulator performance of participants with visual field loss (VFL) from optic disc drusen (ODD) with a normally sighted control group and a group of individuals with glaucoma. Data on performance and safety from a traffic simulator test for five participants with VFL from ODD were retrospectively compared with data from 49 male individuals without visual deficits in a cross-sectional study. VFL of the ODD group was also compared with a group of 20 male glaucoma participants who had failed the same simulator test. Four individuals with ODD regained their driving licences after a successful simulator test and were then followed in a national accident database. All participants with ODD passed the test. No significant differences in safety or performance measures were detected between the normally sighted participants and the ODD group despite severe concentric visual field constrictions. Compared with failed glaucoma male participants, the ODD group had even lower mean sensitivity in the peripheral and peripheral inferior field of vision. None of the four participants with a regained licence were involved in a motor vehicle accident during a 3-year follow-up period after the simulator test. Despite having severe VFL, participants with ODD had no worse performance or safety than controls. As even individuals with severe VFL might drive safely, there is a need for individual practical assessments on licencing issues.

Effects of verbal tasks on driving simulator performance

We report results from a driving simulator paradigm we developed to test the fine temporal effects of verbal tasks on simultaneous tracking performance. A total of 74 undergraduate students participated in two experiments in which they controlled a cursor using the steering wheel to track a moving target and where the dependent measure was overall deviation from target. Experiment 1 tested tracking performance during slow and fast target speeds under conditions involving either no verbal input or output, passive listening to spoken prompts via headphones, or responding to spoken prompts. Experiment 2 was similar except that participants read written prompts overlain on the simulator screen instead of listening to spoken prompts. Performance in both experiments was worse during fast speeds and worst overall during responding conditions. Most significantly, fine scale time-course analysis revealed deteriorating tracking performance as participants prepared and began speaking and steadily improving performance while speaking. Additionally, post-block survey data revealed that conversation recall was best in responding conditions, and perceived difficulty increased with task complexity. Our study is the first to track temporal changes in interference at high resolution during the first hundreds of milliseconds of verbal production and comprehension. Our results are consistent with load-based theories of multitasking performance and show that language production, and, to a lesser extent, language comprehension tap resources also used for tracking. More generally, our paradigm provides a useful tool for measuring dynamical changes in tracking performance during verbal tasks due to the rapidly changing resource requirements of language production and comprehension.

Utilizing driving simulators for persons with multiple sclerosis: A scoping review

ObjectiveThis scoping review synopsized and mapped the evidence on the utility of driving simulators for drivers with Multiple Sclerosis (MS) including participant characteristics (e.g., demographic, clinical) suited to simulator use; and driving scenario environments, maneuvers, and outcomes reflective of driving performance. Data SourcesThe research team searched six databases for English studies on driving simulator performance in drivers with MS. Study SelectionFour reviewers independently screened 976 unique titles, 148 abstracts, and 18 full-text sources for study inclusion or exclusion. Inclusion criteria ensured that studies utilized measures of driving simulator performance in adults 18 years or older with MS. Data ExtractionReviewers independently charted, verified, and achieved consensus on 100% of the data in the extraction table. Data SynthesisThe scoping review included thirteen studies (twelve assessment, one intervention), published between 2001 and 2021. Studies included small samples (N = 11–50) of adults (M age = 36–50 years; 40–91% female), mostly with a relapsing-remitting (53–100%) diagnosis and low to moderate physical disability (Expanded Disability Status Scale score < 6.0). The assessment studies utilized driving scenarios to assess pre-driving (n = 1) or driving abilities (n = 2), responses to hazardous events in suburban (n = 1) or urban environments (n = 4), or the ability to maintain speed or lateral lane positioning during monotonous highway drives (n = 7), with four scenarios also including responses to secondary divided attention tasks. The intervention study utilized driving simulation as a training program to improve driving-related skills. ConclusionsThe evidence on the utility of driving simulators for adults with MS is limited to assessment of driving performance, mostly during monotonous highway drives. Further research should consider exploring how driving simulators can be utilized to assess driving performance in other environments or for intervention. Gender should be examined to support gender diverse populations.

Does Useful Field of Vision Predict Attention While Driving Between Young and Older Adults?

The Insurance Information Institute (2017) reports drivers aged 65 and up are involved in the second highest rate of fatal car crashes. It is important that there is a fair and standardized assessment to test driving fitness. The prime objective was to assess the utility of the Useful Field of View (UFOV) across young and old groups to predict performance on a simulated driving exercise. Community-dwelling adults aged 65 and older (n=48) and students (n=48) recruited from an undergraduate research pool served as participants. They completed a series of demographic, health and cognitive measures, besides a Useful Field of Vison (UFOV) task and a driving simulation exercise. Results showed that collision avoidance and braking varied between age groups, with older adults appearing to be less likely to avoid collision (Older M = 12.46, SD = 10.25, Younger (M = 7.96, SD =4.92; n = 47), but quicker to brake (Older M = 3.64, SD = 3.41, Younger M = 9.79, SD =7.91). There were group differences for driving simulator performance, predicted by cognitive measures (Young; R2 = .099, p = 0.005; Old; R2 = 0.094, p = 0.038). UFOV scores did not predict group differences in driving simulator performance (Young; R2 = 0.009, p = 0.664; β = 0.089, p = 0.437) , (Older; R2 = 0.061, p = 0.522; UFOV-DA β = -0.074, p = 0.555; UFOV_SA β = 0.289, p = 0.194). These findings have implication for the development of pragmatic capacity to drive assessments.

Cognitive Intra-individual Variability in HIV: an Integrative Review.

Nearly 30-50% of people living with HIV experience HIV-Associated Neurocognitive Disorder (HAND). HAND indicates performance at least one standard deviation below the normative mean on any two cognitive domains. This method for diagnosing or classifying cognitive impairment has utility, however, cognitive intraindividual variability provides a different way to understand cognitive impairment. Cognitive intraindividual variability refers to the scatter in cognitive performance within repeated measures of the same cognitive test (i.e., inconsistency) or across different cognitive tests (i.e., dispersion). Cognitive intraindividual variability is associated with cognitive impairment and cognitive decline in various clinical populations. This integrative review of 13 articles examined two types of cognitive intraindividual variability in people living with HIV, inconsistency and dispersion. Cognitive intraindividual variability appears to be a promising approach to detect subtle cognitive impairments that are not captured by traditional mean-based neuropsychological testing. Greater intraindividual variability in people living with HIV has been associated with: 1) poorer cognitive performance and cognitive decline, 2) cortical atrophy, both gray and white matter volume, 3) poorer everyday functioning (i.e., driving simulation performance), specifically medication adherence, and 4) even mortality. This inspires future directions for research. First, greater cognitive intraindividual variability may reflect a greater task demand on executive control to harness and regulate cognitive control over time. By improving executive functioning through cognitive training, it may reduce cognitive intraindividual variability which could slow down cognitive decline. Second, cognitive intraindividual variability may be reconsidered in prior cognitive intervention studies in which only mean-based cognitive outcomes were used. It is possible that such cognitive interventions may actually improve cognitive intraindividual variability, which could have clinical relevance.

P018 The effects of zopiclone on sleep spindles in obstructive sleep apnea: A randomized placebo-controlled trial

Abstract Purpose This study aimed to determine the effects of a standard dose of zopiclone (7.5mg) on sleep spindle activity and to assess if potential changes in sleep spindles correlate with improvements in next-day measures of sleepiness and simulated driving performance in people with obstructive sleep apnoea (OSA). Methods Thirty-one people with OSA completed polysomnography (PSG) at baseline followed by 1-month nightly treatment with 7.5mg zopiclone or placebo according to a double-blind, parallel design (ANZCTRN12613001106729). Participants completed two further PSGs on the first (night1) and final (night30) night of treatment. A 30-min AusEd driving simulator task and a subjective sleepiness questionnaire (Karolinska sleepiness scale, KSS) on each visit were also performed in the morning. Sleep spindle events and spindle frequency activity (SFA, sigma EEG power) were quantified during N2 sleep from all-night EEG recordings. Results Sleep spindle events were consistently higher in both frontal and central EEG sites on night1 and night30 treatment nights in the zopiclone group compared to placebo (e.g. F4 night30 = 346[SEM±28] vs. 239[SEM±27] total # of sleep spindles respectively, p=0.009). Additionally, greater sleep spindle density in the zopiclone group correlated with better next-day simulated driving performance on night1 and night30. No correlations were observed between sleep spindle activity and the KSS. Conclusions Zopiclone is associated with greater sleep spindle activity in OSA compared to placebo, and sleep spindle increases are associated with better driving simulator performance. Thus, hypnotic-induced increases in sleep spindles may help alleviate certain cognitive performance decrements in people with OSA.