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. 2022 Aug 24:16:912766.
doi: 10.3389/fnins.2022.912766. eCollection 2022.

Examining virtual driving test performance and its relationship to individuals with HIV-associated neurocognitive disorders

David Grethlein  1   2 , Vanessa Pirrone  3 , Kathryn N Devlin  4 , Will Dampier  3 , Zsofia Szep  5 , Flaura K Winston  6   7 , Santiago Ontañón  2 , Elizabeth A Walshe  6 , Kim Malone  8 , Shinika Tillman  8 , Beau M Ances  9 , Venk Kandadai  1 , Dennis L Kolson  10 , Brian Wigdahl  3
Affiliations

Examining virtual driving test performance and its relationship to individuals with HIV-associated neurocognitive disorders

David Grethlein et al. Front Neurosci. .

Abstract

Significance: Existing screening tools for HIV-associated neurocognitive disorders (HAND) are often clinically impractical for detecting milder forms of impairment. The formal diagnosis of HAND requires an assessment of both cognition and impairment in activities of daily living (ADL). To address the critical need for identifying patients who may have disability associated with HAND, we implemented a low-cost screening tool, the Virtual Driving Test (VDT) platform, in a vulnerable cohort of people with HIV (PWH). The VDT presents an opportunity to cost-effectively screen for milder forms of impairment while providing practical guidance for a cognitively demanding ADL.

Objectives: We aimed to: (1) evaluate whether VDT performance variables were associated with a HAND diagnosis and if so; (2) systematically identify a manageable subset of variables for use in a future screening model for HAND. As a secondary objective, we examined the relative associations of identified variables with impairment within the individual domains used to diagnose HAND.

Methods: In a cross-sectional design, 62 PWH were recruited from an established HIV cohort and completed a comprehensive neuropsychological assessment (CNPA), followed by a self-directed VDT. Dichotomized diagnoses of HAND-specific impairment and impairment within each of the seven CNPA domains were ascertained. A systematic variable selection process was used to reduce the large amount of VDT data generated, to a smaller subset of VDT variables, estimated to be associated with HAND. In addition, we examined associations between the identified variables and impairment within each of the CNPA domains.

Results: More than half of the participants (N = 35) had a confirmed presence of HAND. A subset of twenty VDT performance variables was isolated and then ranked by the strength of its estimated associations with HAND. In addition, several variables within the final subset had statistically significant associations with impairment in motor function, executive function, and attention and working memory, consistent with previous research.

Conclusion: We identified a subset of VDT performance variables that are associated with HAND and assess relevant functional abilities among individuals with HAND. Additional research is required to develop and validate a predictive HAND screening model incorporating this subset.

Keywords: HIV-associated neurocognitive disorders; driving simulator; impairment detection; screening tool; variable selection.

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Conflict of interest statement

DG was an employee and a vesting shareholder of Diagnostic Driving, Inc. (DDI) (creator of the virtual driving test used in this study). VK was an intellectual property and financial interest in DDI and serves as its President and Chief Executive Officer. DG and VK’s potential of conflict of interest is managed by a conflict management plan from DDI whereby DG and VK had no interactions with study participants (all field data collection procedures were carried out by Drexel University CNAC staff members on Drexel University premises) and all methods and analyses were reviewed and approved by outside consultants with no intellectual or financial interest in DDI (Nicolas Skuli, PhD; a Senior Research Investigator and Director of the Stem Cell and Xenograft Core at the University of Pennsylvania and SO, PhD; an Associate Professor at Drexel University). Additionally, FW and the Children’s Hospital of Philadelphia (CHOP) have an intellectual property and financial interest in DDI. FW served as DDI’s Chief Scientific Advisor. This potential conflict of interest is managed under a conflict-of-interest management plan from CHOP and the University of Pennsylvania whereby FW had no interaction with study participants or involvement in data collection procedures and all analyses were reviewed and approved by outside consultants with no intellectual or financial interests in DDI (John Bolte, a traffic injury researcher at the Ohio State University; and Nancy Kasam-Adams, a behavioral researcher at CHOP and the University of Pennsylvania). The reviewer LF declared a shared affiliation with the authors FW and DK to the handling editor at the time of review. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Analytical workflow for dimensionality reduction via a two-stage variable selection.
FIGURE 2
FIGURE 2
The Jaccard similarity score comparing all pairs of “top 100 variables” rankings lists, with the true size of the intersection (number of shared VDT performance variables selected in both intermediate rankings lists) annotated in each cell.
See this image and copyright information in PMC

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