Motor vehicle crashes in dementia of the alzheimer type

Abstract

To assess the occurrence and related features of motor vehicle crashes in patients with dementia of the Alzheimer type (DAT) we studied 30 patients who had been followed longitudinally and 20 healthy age-matched control subjects. Data were gathered from first-degree relatives who had lived with the subjects for the previous 5 years or more. Forty-seven percent of the DAT patients incurred at least one crash while they were driving, whereas only 10% of the control subjects had had a crash in the previous 5 years. The odds ratio for crashes in the DAT group was 7.9 (p less than 0.01). Moreover, in 77% of DAT patients, a deterioration in driving performance was noted, and 63% of the patients had stopped driving. However, only 42% of the DAT patients who stopped driving did so before a crash occurred. Mean illness duration was 4.0 (+/- 1.8) years, and the mean Mini-Mental Status Examination score was 19.9 (+/- 6.3) at the time of the first crash in the DAT group. The occurrence of crashes was not significantly correlated with dementia severity or with disease duration. These data suggest that the occurrence of driving crashes in patients with DAT is an important public health problem.

Driving and Dementia in Ontario: A Quantitative Assessment of the Problem

“…Drivers in the earliest stage of dementia may pose relatively little risk, but with disease progression, they will become increasingly dangerous to themselves and others, until they are no longer capable of driving. Crash data studies have demonstrated that drivers with dementia are 2 to 5 times more likely to be involved in a collision, compared with drivers with no dementia (18,22). Further, several studies have shown that individuals with dementia are most likely to be involved in crashes at intersections, (23,24) suggesting that more than one vehicle is involved.…”

Neurologic Conditions: Assessing Medical Fitness to Drive

“…44,50 Since this tool was not originally designed to assess cognitive function with respect to driving, the MMSE as a measure to assess driving performance lacks validity when used to assess patients falling between the extremes of cognitive impairment. 7,51 The Useful Field of View (UFOV) is a computer-administered test that measures and detects abnormalities in the speed of visual processing and sensory function. UFOV also measures skills in selective and divided attention.…”

“…45,46,[56][57][58] These studies may be confounded because of the failure to control for the amount of mileage actually driven, lack of control groups, small sample size, method of reporting and avoidance of high risk driving situations. [44][45][46]51,59 Overall, the evidence does support an increased risk of motor vehicle collisions in patients with dementia even with restrictions attached to driving, such as driving distance or location. 51,60-62…”

“…Despite the diagnosis, most patients with Alzheimer's disease continue to drive for as long as 4 years. 44,51 Given the heterogeneity among patients with widely ranging cognitive dysfunction, it is important to assess patients systematically and to individualize recommendations. 56…”

Cognitive Abilities Related to Driving Performance in a Simulator and Crashing on the Road

“…It is known that patients with Alzheimer's disease (AD) become unsafe drivers (e.g., Friedland et al, 1988;Rizzo et al, 2001;Rizzo et al, 1997;Tuokko et al, 1995). However, this diagnosis alone is not sufficient grounds for restricting driving privileges, as some patients in the early stages of this progressive condition may have only isolated memory deficits and may maintain driving ability comparable to their non-dementing peers.…”