Practice parameter: Risk of driving  and Alzheimer’s disease (an evidence-based review) [RETIRED]

Dubinsky, Richard; Stein, Anthony C.; Lyons, Kelly E.

doi:10.1212/wnl.54.12.2205

Cited by 286 publications

(103 citation statements)

References 23 publications

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“…41,47 The CDR is scored from 0 to 2. Higher scores reflect a greater impairment in cognitive functional abilities of daily living.…”

Section: Methods Of Assessmentmentioning

confidence: 99%

“…Higher scores reflect a greater impairment in cognitive functional abilities of daily living. 47 Alzheimer's patients with a CDR score of >1.0 have been shown to have a higher risk of collisions and should be advised not to drive. Patients with a score of 0.5 should be evaluated every 6 months and undergo a formal driving examination.…”

Section: Methods Of Assessmentmentioning

confidence: 99%

“…Patients with a score of 0.5 should be evaluated every 6 months and undergo a formal driving examination. 47 Up to 50% of these patients progress to the next or higher stage of cognitive dysfunction within 1 year. 48 Visuospatial impairment tests, especially the applicable subsections of the Mattis Dementia Rating Scale and Folstein Mini-Mental Status Examination (MMSE), have been used to identify patients considered safe to drive.…”

Section: Methods Of Assessmentmentioning

confidence: 99%

“…These patients require evaluation by neuropsychiatric testing and possible driving performance evaluation. 63 The neuropsychologist is a useful resource in educating the patient and family regarding management of cognitive deficits and also in assisting the patient and family in discussions regarding safety (to themselves and others). As well as, financial ramifications which may occur if the patient continues to drive against medical advice.…”

Section: Driving With Dementia Guidelinesmentioning

confidence: 99%

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Neurologic Conditions: Assessing Medical Fitness to Drive

Yale¹,

Hansotia²,

Knapp³

et al. 2003

Clinical Medicine & Research

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Clinicians are often asked to make an assessment on whether a patient is medically fit to drive, even though few have been formally trained in this area. Driving is a complex task that requires having adequate operational, cognitive and higher executive functions that work together. These functions can be compromised to a greater or lesser extent in neurological disorders, such as stroke, traumatic brain injury, peripheral neuropathy, dementia, Parkinson's disease and epilepsy. There is insufficient standardized information relating to impaired function at this time. Because of this, state laws vary in their assessment of medical conditions as they relate to driver licensing. Wisconsin laws are reviewed as an example. There are numerous assessment tests for various functions, but they lack a validated correlation with actual driving performance. These and other factors, as well as practical recommendations for the practicing physicians, are the subjects of this review.

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“…41,47 The CDR is scored from 0 to 2. Higher scores reflect a greater impairment in cognitive functional abilities of daily living.…”

Section: Methods Of Assessmentmentioning

confidence: 99%

Section: Methods Of Assessmentmentioning

confidence: 99%

Section: Methods Of Assessmentmentioning

confidence: 99%

Section: Driving With Dementia Guidelinesmentioning

confidence: 99%

See 2 more Smart Citations

Neurologic Conditions: Assessing Medical Fitness to Drive

Yale¹,

Hansotia²,

Knapp³

et al. 2003

Clinical Medicine & Research

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show abstract

“…Previously, we addressed this question for drivers with dementia, through a systematic literature review. 1 This evidence-based medicine practice parameter reported that there was an increased risk of collisions for drivers with a clinical dementia rating scale score of 0.5 (possible Alzheimer's disease) and 1 (probable Alzheimer's disease) compared to nondemented drivers. The clinical dementia rating is a complex rating scale, based on a structured interview, encompassing many domains, and not easily adaptable to a brief clinical encounter.…”

mentioning

confidence: 99%

Minimal hepatic encephalopathy and driving

Dubinsky

Stein

2009

Hepatology

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O perating a motor vehicle is an overlearned motor task involving aspects of divided attention and visual perception (surveillance of roadway, traffic, and regulatory and informational signage), and time-on-task, accomplished by multiple limb-coordinated motions. Driving is a privilege granted by the government based on age (reflecting driver maturity), minimal performance standards (corrected vision, passing a written and a performance test under low workload conditions), and restricted based on bad experience (moving violations and collisions). Society tolerates the increased risk of the immature driver, because the only way their driving skills improve and the risk of collisions decrease is with practice. A trained driving examiner makes the licensing decision for the immature driver on behalf of the State. Society, through the legislative process, has restricted driving for certain conditions or driving violations. For example, States have progressively tightened the permissible level of breath alcohol concentration of drivers to a uniform 0.08 mg/dL. Through the same mechanism, some jurisdictions have increased the frequency of testing of older drivers and required physician reporting of potentially impaired drivers.Physicians are not trained to determine fitness-todrive. Thus, when called upon by a patient or their family to answer the question "can they drive?" the physician has no basis on which to base a decision. Previously, we addressed this question for drivers with dementia, through a systematic literature review. 1 This evidence-based medicine practice parameter reported that there was an increased risk of collisions for drivers with a clinical dementia rating scale score of 0.5 (possible Alzheimer's disease) and 1 (probable Alzheimer's disease) compared to nondemented drivers. The clinical dementia rating is a complex rating scale, based on a structured interview, encompassing many domains, and not easily adaptable to a brief clinical encounter. Of the many psychometric tests used in the studies of driving in people with dementia, only Trails A (as part of a regression analysis including age, sex, and driving history) and the Sternberg Test (a triarchic memory test) were partially predictive of future crash risk. 2,3 Thus far, no simple psychometric test has been found to have a threshold level robust enough to reliably divide drivers into high or low risk for future crashes. This is because driving is a complex task involving many cognitive domains, and collisions are rare events that involve both capable and impaired drivers.Bajaj and colleagues present an interesting report of motor vehicle crashes in drivers with cirrhosis, with and without minimal hepatic encephalopathy (MHE) over a 2-year period. 4 After measuring cognition with a brief psychometric test battery, and the inhibitory control test (ICT), the drivers were assigned to either the MHE cohort or the non-MHE cohort. Collision and violation data were collected by self-report and from the Department of Transportation for the year befor...

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