When People With Alzheimer's Disease Should Stop Driving: AAN Issues Guideline

The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology, and was presented April 12, 2010, at the American Academy of Neurology's Annual Meeting in Toronto.



"While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, with the Humboldt Neurological Medical Group, Inc. in Eureka, Calif., and Fellow of the American Academy of Neurology. "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis since restricted driving will affect the patient's quality of life and may lead to other health concerns such as depression."



The guideline recommends doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.



Evidence shows driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors caring for these patients to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."



The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.



Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:
Decreased miles being driven


Collisions


Moving violations


Avoiding certain driving situations, such as driving at night or in the rain


Aggressive or impulsive personality traits

"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."



Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact their ability to drive safely.



The guideline is an update of the 2000 American Academy of Neurology guideline on driving with dementia.