No abstract

The purpose of this article is to review the literature on the ability of individuals with dementia to drive an automobile. Based on a review of the literature, several factors were identified that may be useful in differentiating between people with dementia who presently remain safe drivers from those who have progressed to impaired driving. These factors include disease duration and severity, sex, patient self-assessment, family assessment, neuropsychological measures, findings on road evaluations, and driving simulator testing. The approach of the physician to driving and dementia is addressed, including in-office screening, referral for on-road driving assessments, and the potential for physician reporting to state agencies. Keywords dementia; driving; competence; impairmentWith the increasing age of the American population, the proportion of older drivers on the road is also rising. 1 Given that age is the most significant risk factor for developing dementia, it is apparent that large numbers of licensed drivers in North America are demented or are likely to become demented. Studies have shown that the driver with dementia is at increased risk to cause traffic accidents. [2][3][4][5] Friedland and coworkers found a 47% prevalence rate of crashes among 30 persons with Alzheimer's disease (AD) compared to 10% of 20 age-matched controls in a retrospective survey over 5 years. 6 Overall, there is probably a 2-to 8-fold greater risk of crashes for elderly drivers with mild to moderate dementia compared to those not demented. 7 A recent longitudinal study of drivers with dementia confirmed the decline of on-road driving abilities, particularly on aspects of the driving exam requiring more complex abilities such as awareness of driving environment and decision making. 8 Thus, among those who continue to drive, dementia is a well-recognized, age-related risk factor for hazardous driving. A number of editorials and review articles have addressed the issue of driving and dementia. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] There is evidence to suggest, however, that not all persons with dementia are incompetent drivers, particularly in the very early stages. [28][29][30][31][32] Given this evidence, it is particularly important to determine the most important cognitive or functional factors that contribute to driving impairment among those with dementia.

This independent confirmation of data from phase 3 trials suggests that donepezil therapy modestly improves cognition in patients with Alzheimer disease who are encountered in clinical practice.

OBJECTIVES-Physicians and family members frequently are asked to provide information about driving ability in patients with Alzheimer's disease (AD), yet there has been little research on the validity of their assessments of driving performance. DESIGN-Cross-sectional.SETTING-Participants were recruited from the neurology department of a community hospital affiliated with Brown Medical School.PARTICIPANTS-Participants included 75 older adults (17 with mild AD, 33 with very mild AD, and 25 elderly controls). MEASUREMENTS-The participant him/herself, an informant, and an experienced neurologist rated each participant's driving ability on a 3-point rating scale (safe, marginal, unsafe). A professional driving instructor also completed a standardized 108-point on-road driving assessment of each participant and then rated driving ability on the 3-point scale. Ratings were compared with the on-road driving score and with each other. RESULTS-Only the neurologist's rating of the participants' driving abilities was significantly related to on-road driving score. When related to the instructor's safety rating, the neurologist's ratings were the most sensitive and specific. Mini-Mental State Examination score was a borderline covariate for the neurologist's rating. Overall, the instructor was the most stringent rater of participant driving ability, followed by the neurologist, the informant, and the participant. Increasing attention has been placed recently on evaluating the competence of drivers with early dementia. For an individual with mild dementia, driving cessation is often a difficult and life-changing decision and can lead to problems with adequate transportation, disruption of caregivers' lives, and increased depressive symptoms in the patient. [1][2][3][4][5] The need to balance public safety with the adverse effects of driving cessation underscores the importance and the difficulty of determinations regarding driving competence. CONCLUSION-AnAs part of the evaluation of driving ability, patients and their families often are asked to provide information about the patient's ability to operate a motor vehicle. Not surprisingly, patients' poor insight 6,7 is often reflected in their self-assessments of their driving abilities, which frequently differ from their actual driving abilities. [8][9][10][11][12] The value of informants' assessments of a dementia patient's ability to drive a car is more uncertain. Some studies have found that family members may not be good judges of patients' driving skills. 8,13 In contrast, informant ratings of patients' abilities have been linked to motor vehicle accidents in another study, although this study was retrospective. 14 Although a physician's opinion often is a critical factor in a patient's decision to stop driving, 3,15 only one study examined physicians' ability to accurately predict on-road driving ability, finding that, although the physician's prediction (pass, borderline, or fail) of the patient's abilities correlated with total score on the driving test, it w...