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Dementia and Driving Don't Mix

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After one such episode, one of Susan's sisters exercised a durable power of attorney and had Walter admitted "to a secure Alzheimer's unit. ... Our whole family has been in upheaval," says Susan. She says that she is glad the AAN is issuing guidelines so that "other families may be spared."

Dubinsky adds that some states require physicians to inform the departments of motor vehicles about the need to prohibit driving. In California, for example, Alzheimer's disease is a diagnosis that must be reported to the DMV, which automatically revokes the patient's license. Patients are, however, allowed an appeal.

In addition to issuing the new guidelines, the AAN says that research is still needed to determine if there are a subsets of patients with Alzheimer's with moderate dementia who can drive safely, or who can drive safely with enforceable restrictions," such as non-highway driving or driving within a limited geographic area.

While the Alzheimer's Association agrees that people with milder Alzheimer's disease should be discouraged from driving, it released a prepared statement in response to the guidelines, saying "the final determination is one that should be made with full involvement of the individual with the disease, their caregiver, and their health care provider."

"It is very appropriate for the AAN to have some guidelines, and I think these guidelines are very reasonable," says Morris, who on the Alzheimer's Association board of directors. "The problem is that guidelines do not apply to every individual case."

"There are not many studies of people with defined Alzheimer's who have actually been assessed on their ability to handle an automobile in every day, real life situations," he adds. In his own work he has used driving instructors and other "driving evaluators" to assess driving skills. As a result, he says, there are people with mild dementia who are considered safe drivers by professionals who have evaluated their actual driving.

Morris says that a broad application of the new guidelines could "result in some individuals who would have their mobility restricted prematurely." He urges taking an individualized approach for patients whose families or caregivers are not reporting driving problems. He says that driving evaluations can usually be "arranged through occupational therapy departments."

Allen has her own suggestions for coping. She says when it comes to getting loved ones with Alzheimer's disease to stop driving, there are some important things to remember. Cars equal freedom, and the desire to drive is deeply connected to a good lifestyle. See how much of the patient's lifestyle you can keep intact by researching the public transportation available in your community, she says. Some towns offer discounts to seniors, and under the Americans With Disabilities Act, Alzheimer's patients may be entitled to some type of transportation, she says. Also, groups like the American Red Cross offer regular trips to the grocery store in a van with a certified driver.

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