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

Objective: 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.
Methods: 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.
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.
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. 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，避免驶入高速公路或陌生区域。本研究旨在对比HD基因携带者与健康个体在模拟城市及高速公路驾驶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，其中28名为症状前HD患者、30名为症状期HD患者，剩余29名为健康对照者。所有受试者均为有经验的活跃驾驶员，研究采用驾驶模拟器、驾驶史问卷及统一亨廷顿舞蹈症评定量表对其进行评估。驾驶模拟器测试涵盖城市道路与高速公路两种驾驶场景。采用方差分析与克鲁斯卡尔-沃利斯检验，对比三组受试者在两类驾驶场景下的表现。

**研究结果**：当限速提升至80 km/h及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；在高速公路及30 km/h限速区域，其车速稳定性均差于症状前HD患者。此外，在高速公路场景下，症状期HD患者的侧向位置标准差显著大于健康对照者与症状前HD患者，即车辆蛇行频次更高、车辆操控性更差。

**研究结论**：相较于症状前HD患者与健康对照者，症状期HD患者在限速提升时的驾驶行为更为谨慎，但在高速公路场景下的车辆操控性更差。驾驶模拟器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评估症状期HD患者驾驶能力变化的可行工具。