Driving and Dementia: A Review of the Literature

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.

Predictors of driving cessation in mild-to-moderate dementia

“…[4][5][6][7]9 These same factors have also been shown to increase the risk of motor-vehicle collisions in people with dementia. 10 Male gender has been associated with a higher risk of crashes and moving violations; 22 it is notable that at baseline, we found women to be significantly likelier than men to have already quit driving.…”

A Longitudinal Study of Drivers With Alzheimer Disease

“…Among those that discuss severity of dementia, all recommend cessation of driving for those with moderate to advanced dementia; however, consensus is lacking regarding those with mild dementia. 1 Most of the published guidelines note that driving abilities are unclear inpatients with mild dementia and often recommend professional assessment of driving impairment. [25][26][27][28] Some guidelines have recommended those with a history of traffic accidents, spatial or executive/judgment impairment be particularly scrutinized.…”

Reduced Physical Fitness in Patients With Heart Failure as a Possible Risk Factor for Impaired Driving Performance

“…Driving simulation and the 2MST are safe, costeffective, and valid methods for assessing driving abilities and physical fitness, respectively (Brown & Ott, 2004;Garcia et al, 2013;Reger et al, 2004). However, future work using on-road testing and more rigorous measures of physical fitness (e.g., stress testing) is much needed to increase the ecological validity of the current findings.…”