Dementia and Driving Don't Mix
June 26, 2000 -- Wes is 71 and has been driving a car for all of his adult
life. His wife, Joyce, says that his most recent job was driving rental cars
back to an agency at the airport in St. Louis. Walter, 83, a retired steel
company executive, also loved to drive, especially around the suburban streets
of Naperville, Ill., says his daughter Susan.
In addition to a love of the open road, Wes and Walter share something else:
Both men have dementia, and both have frightened their family and friends with
their on-the-road escapades.
According to the Alzheimer's Association, approximately 4 million people in
the U.S. have Alzheimer's disease, and it is estimated that the number could
increase to 14 million by 2050, making the prospect of sharing a lane with an
Alzheimer's afflicted driver not such a remote possibility.
The risk that these drivers pose to themselves and others is serious enough
that the American Academy of Neurology is now telling physicians when to take
away a patient's driving privileges. In the new guidelines, issued in the June
27 journal Neurology, the academy says that a person with Alzheimer's
disease and moderate dementia has a "substantially increased accident
rate" and should not drive.
Neurologists consider a person with moderate dementia to be one who has some
difficulty remembering recent events, such that the difficulty interferes with
everyday activities. For example, this person might no longer be able to
balance a checkbook or may stop a hobby such as woodworking. The person can
take care of normal activities such as showering but may need some prompting to
initiate the task.
Richard M. Dubinsky, MD, tells WebMD that the AAN's quality standards
subcommittee reviewed more than 200 published studies to develop the new
guidelines. The evidence is clear: People with moderate or worse dementia
"pose a significant traffic safety risk," says Dubinsky, who is lead
author of the AAN guideline report.
Dubinsky, an associate professor and vice-chair of the department of
neurology at the Kansas University Medical Center in Kansas City, says that
people with very mild dementia "are impaired but may continue to drive if
they are closely monitored." He says that the guideline recommends that
these patients have their driving skills evaluated every six months.
Although he is reluctant to make blanket statements about driving ability,
John C. Morris, MD, professor of neurology at Washington University School of
Medicine, agrees. "These patients need to be re-evaluated every six months
because eventually every Alzheimer's patient will be an unsafe driver," he
says. Morris was not involved in drafting the guidelines but says he served as
a reviewer for the guidelines.
Louise H. Allen, PhD, says it slowly became apparent to her that her
husband's driving days were winding down. He was in the early stages of
Alzheimer's disease and he was having trouble recognizing his children. Her
clandestine reviews of the checkbook showed that he had trouble keeping track
of the finances.