{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T17:05:53Z","timestamp":1770915953180,"version":"3.50.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2022,7,17]],"date-time":"2022-07-17T00:00:00Z","timestamp":1658016000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>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\u2010simulator 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\u2010edge 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\u2010Stage 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\u2010 and substance abuse\u2010impairment goggles, CCs increased but REEs decreased in cirrhosis. In the GLM, a time and group interaction was seen (<jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0&lt;\u20090.001) for CCs and REEs. Patients with cirrhosis showed higher CCs and REEs at baseline than controls (CCs, <jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.003; REEs, <jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.0001) and higher CCs (<jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.03) and lower REEs (<jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.001) with alcohol\u2010simulating goggles. All groups were equally impaired with opioid\/benzodiazepine\u2010simulating goggles (CCs, <jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.49; REEs, <jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.46). Controls with alcohol\u2010simulating goggles had similar CCs as the baseline of patients with cirrhosis (<jats:italic toggle=\"yes\">p<\/jats:italic>\u00a0=\u20090.98). <jats:italic toggle=\"yes\">conclusions<\/jats:italic>: Simulating alcohol intake induces greater driving impairment in patients with cirrhosis versus controls, but similar patterns were seen with opioid\/benzodiazepine\u2010simulating 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.<\/jats:p>","DOI":"10.1002\/hep4.2028","type":"journal-article","created":{"date-parts":[[2022,7,17]],"date-time":"2022-07-17T17:23:35Z","timestamp":1658078615000},"page":"2867-2875","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Substance\u2010use simulation impairs driving capability in patients with cirrhosis regardless of hepatic encephalopathy"],"prefix":"10.1097","volume":"6","author":[{"given":"Chathur","family":"Acharya","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"McGeorge","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Fagan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James B.","family":"Wade","sequence":"additional","affiliation":[{"name":"Department of Psychiatry,Virginia Commonwealth University,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0764-9737","authenticated-orcid":false,"given":"Hannah","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Velimir","family":"Luketic","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8637-2475","authenticated-orcid":false,"given":"Richard K.","family":"Sterling","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leroy","family":"Thacker","sequence":"additional","affiliation":[{"name":"Department of Biostatistics,Virginia Commonwealth University,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Virginia Commonwealth University and Richmond VA Medical Center,Richmond,Virginia,USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2022,7,17]]},"reference":[{"issue":"1","key":"hep42028-bib-0001-20241127","article-title":"Reported prevalence of health conditions that affect drivers","volume":"4","year":"2017","journal-title":"Cogent 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