Altered driving performance of symptomatic Huntington’s disease gene carriers in simulated road conditions

<b>Objective:</b> In clinical practice, patients with Huntington’s disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments. <b>Methods:</b> This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington’s Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups. <b>Results:</b> 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. <b>Conclusions:</b> 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. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD.

**研究目的：** 临床实践中，亨廷顿舞蹈症（Huntington’s disease, HD）患者通常仅选择在熟悉的社区内驾车，而非高速公路或陌生区域。本研究旨在对比亨廷顿病基因携带者与健康个体在模拟城市及高速公路环境下的驾驶表现差异。
**研究方法：** 本横断面研究共纳入87名受试者（28名症状前HD患者、30名症状期HD患者及29名健康对照者）。所有受试者均为当前仍在驾驶的驾驶员，通过驾驶模拟器（driving simulator）、驾驶史问卷及统一亨廷顿病评定量表（Unified Huntington’s Disease Rating Scale）进行评估。驾驶模拟器测试涵盖城市及高速公路驾驶场景。本研究采用方差分析（Analysis of variance）与克鲁斯卡尔-沃利斯检验（Kruskal-Wallis tests）对三组受试者的城市及高速公路驾驶表现进行比较。
**研究结果：** 当限速提升至80、100 km/h时，症状期HD患者的驾车速度慢于健康对照者与症状前HD患者；且在高速公路及30 km/h限速区域内，其车速稳定性较症状前HD患者更差。此外，在高速公路场景中，症状期HD患者的侧向位置标准差（即车辆更易偏移、车辆操控性更差）较健康对照者与症状前HD患者更大。
**研究结论：** 相较于症状前HD患者与健康对照者，症状期HD患者在限速提升时于驾驶模拟器中表现得更为谨慎，且在高速公路场景下的车辆操控性更差。驾驶模拟器的相关参数可有效区分症状期HD患者与健康个体，因此驾驶模拟器可作为研究症状期HD患者驾驶表现变化的可行评估工具。