Driving With Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

As most physicians will tell you, one of the barriers preventing patients from pro-actively voicing memory concerns is the patients' fear of losing the right to drive. However, the medical system is poorly equipped to assess driving ability and the steps between discussing a cognitive concern with a doctor and losing one's driving license are not as clear or straight forward as most patients would presume.

One the one hand, we all empathize with the natural desire to remain independent and, in the USA, where public transportation is spotty at best, the right to drive is a key enabler of independence. On the other hand, driving is a judgment intensive activity and impaired drivers need to be taken off the roads for everyone's safety.

The reality is that a patient must be severely impaired before actions initiated in the medical system will result in the loss of driving privileges. The American Academy of Neurology recently updated guidelines to help their members better assess driving skills as part of delivering comprehensive care. The new guidelines can be downloaded at their site.

The principle findings of the panel that issued the guidelines were that patients and caregivers are not very reliable sources of information about the patients' driving skills nor are standard neuro-psychological tests like the Mini-Mental State Exam. One of the best indicators that the patient may no longer drive safely is if they admit to having changed driving habits to avoid challenges such as driving in unfamiliar locations or night time driving.

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