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The neurological deficits contributing to impair driving and the underlying mechanisms are poorly understood. Early detection of driving impairment would help to reduce traffic accidents in <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content> patients. It would be therefore useful to have psychometric or biochemical parameters reflecting driving impairment. The aims of this work were as follows: (i) to shed light on the neurological deficits contributing to impair driving; (ii) to assess whether some psychometric test or biochemical parameter is a good indicator of driving impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed in 22 controls, 36 cirrhotic patients without and 15 with <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>, driving performance using a driving simulator (<jats:styled-content style=\"fixed-case\">SIMUVEG<\/jats:styled-content>) and Driver Test. <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content> was diagnosed using the psychometric hepatic encephalopathy score (<jats:styled-content style=\"fixed-case\">PHES<\/jats:styled-content>). Psychometric tests assessing different neurological functions (mental processing speed, attention, visuo\u2010spatial and bimanual coordination) were performed. Blood ammonia and parameters related with nitric oxide\u2010<jats:styled-content style=\"fixed-case\">cGMP<\/jats:styled-content> metabolism, <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106, <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u201018 and 3\u2010nitrotyrosine were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content> showed impaired driving ability correlating with <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content> grade, with impaired vehicle lateral control in spite of reduced driving speed. Patients with <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content> show psychomotor slowing, longer reaction times, impaired bimanual and visuo\u2010spatial coordination and concentrated attention and slowed speed of anticipation and increased blood ammonia, <jats:styled-content style=\"fixed-case\">cGMP<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> IL<\/jats:styled-content>\u20106, <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u201018 and 3\u2010nitrotyrosine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Impaired mental processing speed, attention and alterations in visuo\u2010spatial and motor coordination seem main contributors to impaired driving ability in patients with <jats:styled-content style=\"fixed-case\">MHE<\/jats:styled-content>. Increased serum 3\u2010nitrotyrosine is associated with impaired driving ability.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12206","type":"journal-article","created":{"date-parts":[[2013,5,9]],"date-time":"2013-05-09T07:13:42Z","timestamp":1368083622000},"page":"1478-1489","source":"Crossref","is-referenced-by-count":38,"title":["Serum nitrotyrosine and psychometric tests as indicators of impaired fitness to drive in cirrhotic patients with minimal hepatic encephalopathy"],"prefix":"10.1111","volume":"33","author":[{"given":"Vicente","family":"Felipo","sequence":"first","affiliation":[{"name":"Laboratory of Neurobiology Centro de Investigaci\u00f3n Principe Felipe Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amparo","family":"Urios","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Investigaci\u00f3n Hospital Cl\u00ednico Universitario de Valencia INCLIVA Valencia 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