Preliminary report of the hepatic encephalopathy assessment driving simulator (HEADS) score

Edwina S. Baskin-Bey, Charmaine A. Stewart, Mary M. Mitchell, John P. Bida, Theodore J. Rosenthal, Scott L. Nyberg

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: Audiovisual simulations of real-life driving (ie, driving simulators) have been used to assess neurologic dysfunction in a variety of medical applications. However, the use of simulated driving to assess neurologic impairment in the setting of liver disease (ie, hepatic encephalopathy) is limited. Objectives: The aim of this analysis was to develop a scoring system based on simulated driving performance to assess mild cognitive impairment in cirrhotic patients with hepatic encephalopathy. Methods: This preliminary analysis was conducted as part of the Hepatic Encephalopathy Assessment Driving Simulator (HEADS) pilot study. Cirrhotic volunteers initially underwent a battery of neuropsychological tests to identify those cirrhotic patients with mild cognitive impairment. Performance during an audiovi-sually simulated course of on-road driving was then compared between mildly impaired cirrhotic patients and healthy volunteers. A scoring system was developed to quantify the likelihood of cognitive impairment on the basis of data from the simulated on-road driving. Results: Mildly impaired cirrhotic patients performed below the level of healthy volunteers on the driving simulator. Univariate logistic regression and correlation models indicated that several driving simulator variables were significant predictors of cognitive impairment. Five variables (run time, total map performance, number of collisions, visual divided attention response, and average lane position) were incorporated into a quantitative model, the HEADS scoring system. The HEADS score (0-9 points) showed a strong correlation with cognitive impairment as measured by area under the receiver-operator curve (.89). Conclusion: The HEADS system appears to be a promising new tool for the assessment of mild hepatic encephalopathy.

Original languageEnglish (US)
Pages (from-to)357-364
Number of pages8
JournalEthnicity and Disease
Issue number3
StatePublished - Jun 2008


  • Cirrhosis
  • Neuropsychological tests
  • Scoring system

ASJC Scopus subject areas

  • Epidemiology


Dive into the research topics of 'Preliminary report of the hepatic encephalopathy assessment driving simulator (HEADS) score'. Together they form a unique fingerprint.

Cite this