Evaluation and Management of the Driver with Dementia

Dobbs, Bonnie; Carr, David B.; Morris, John C.

doi:10.1097/00127893-200203000-00001

Cited by 55 publications

(70 citation statements)

References 40 publications

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“…Performance-based measures of driving skills, such as onroad driving tests, are recommended as a means of assessing driving competency. [239][240] A traffic-interactive, performancebased road test that examines cognitive behaviours provides an accurate and reliable functional assessment of driving ability.…”

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confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

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confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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“…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.…”

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confidence: 99%

Driving and Dementia: A Review of the Literature

Brown

Ott

2004

J Geriatr Psychiatry Neurol

123

119

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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.

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“…There are no clinical tests available to predict driving ability in patients with cognitive impairment. On-road assessments have been described as a more reliable method (Lloyd et al, 2001;Dobbs et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

“…Driving and cognitive impairment remains an understudied area and there are no clinical tests of cognitive impairment that closely correlate with or can accurately predict driving ability (Withaar et al, 2000;Dobbs et al, 2002). This issue will increase in significance as the population ages and may be complicated by the use of cholinesterase inhibitors, which may slow disease progression.…”

Section: Discussionmentioning

confidence: 99%

Driving, dementia and the Driver and Vehicle Licensing Agency: a survey of old age psychiatrists

Naidu¹,

McKeith

2006

Psychiatr. bull.

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Aims and MethodWe surveyed old age psychiatrists in the north-east of England to determine what they considered relevant indicators of driving ability. The survey asked about their satisfaction with the current Driver and Vehicle Licensing Agency (DVLA) procedure of assessing competence to drive in patients with dementia and how they thought this could be improved.ResultsFifty-seven out of 76 psychiatrists (75%) responded; 26 (45%) respondents thought the forms issued by the DVLA were unsatisfactory but 32 (57%) were satisfied with the eventual decisions made about individual patients. Factors thought to be relevant indicators of driving ability were occupational therapy (n=46, 81%), neuropsychological assessments (n=43, 75%) and carer's report of driving (n=48, 84%). Factors thought not to be relevant were patient's report of driving ability (n=13, 23%) and the Mini Mental State Examination (n=21, 38%).Clinical ImplicationsThe current system for determining driving ability in people with cognitive impairment and dementia was felt to be unsatisfactory. A multidisciplinary approach and use of on-road driving assessments may improve decision-making.

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Evaluation and Management of the Driver with Dementia

Cited by 55 publications

References 40 publications

Systematic review of recent dementia practice guidelines

Systematic review of recent dementia practice guidelines

Driving and Dementia: A Review of the Literature

Driving, dementia and the Driver and Vehicle Licensing Agency: a survey of old age psychiatrists

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