Objective: To investigate if differences in driving performance between Huntington’s disease (HD) gene carriers and healthy individuals can be detected with a driving simulator. Furthermore, we wanted to determine if certain cognitive and motor symptoms contribute to driving performance in HD.

Background: The ability to drive a car is important for an individual’s independence, work, and social activities. HD patients become more and more dependent in their daily life activities as the disease progresses and, for most patients, it can be difficult to quit driving.

Methods: We included 58 HD gene carriers (28 premanifest HD, 30 manifest HD) and 29 controls in this cross-sectional study. All participants were active drivers and assessed using a driving simulator, a driving history questionnaire, the Unified Huntington’s Disease Rating Scale, and neuropsychological assessments. The driving simulator session included both urban and motorway scenarios.

Results: 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 performed worse on all clinical assessments compared to controls. Postural instability and slower speed of processing were predictors of the driving simulator outcome measures. There were no significant differences between premanifest HD and controls.

Conclusions: 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. A driving simulator is able to detect differences in driving performance between manifest HD and healthy individuals. Lower performances on cognitive tasks might assist physicians in their referral for an official on-road driving test. A genetic confirmation of HD should not be decisive in the advice to cease driving. Further studies are necessary to determine if a driving simulator can be used to monitor longitudinal changes in fitness to drive. Investigating fitness to drive is important in HD, because symptoms of the disease can affect the ability to drive at a relatively young age.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/driving-performance-of-huntingtons-disease-gene-carriers/