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When Should Dementia Patients Stop Driving?

American Academy of Neurology Offers Guidelines for Taking Away the Car Keys
By
WebMD Health News
Reviewed by Laura J. Martin, MD

April 13, 2010 (Toronto) -- If a family member with Alzheimer's disease or other dementia is racking up traffic tickets, getting in repeated fender benders, or exhibiting road rage, it may be time to think about taking away the car keys.

About 4 million Americans have some type of dementia and nearly all will eventually have to give up driving, says Donald J. Iverson, MD, of the Humboldt Neurological Medical Group, Inc., in Eureka, Calif.

It’s one of the most wrenching decisions a family has to make, forcing the patient to face a loss of autonomy, Iverson tells WebMD. And there's no hard rule or simple test to tell when a person is poised to become a danger, he says.

In an effort to offer some guidance to patients and their families, Iverson and other experts convened by the American Academy of Neurology (AAN) recently combed through 6,000 studies and articles to arrive at new guidelines on dementia and driving.

The recommendations were released here at the AAN's annual meeting and simultaneously published online by the journal Neurology.

Crafting New Guidelines

The Academy's previous guidelines recommended that all people with mild dementia give up driving, Iverson says.

But recent studies present a conundrum, he says. "On the one hand, there is research showing people with dementia are up to 88% more likely to fail a driving test than people without dementia," Iverson says. "On the other hand, some studies show as many as 76% of people with mild dementia can pass an on-road driving test and can safely drive."

Faced with the conflicting research, the guidelines committee concludes that "patients with mild dementia should strongly consider stopping driving," he says.

The guidelines can help identify people at higher risk of unsafe driving, without unnecessarily restricting people who don't pose a danger, he says.

In creating the guidelines, the committee generally defined safe driving as being able to pass a road test. "It's not a perfect measure, but based on the evidence, it's the best we have," Iverson says.

Identifying Unsafe Drivers

One of the best ways to identify unsafe drivers, according to the guidelines, is a standard test called the Clinical Dementia Rating (CDR) scale. Administered by a doctor with input from caregivers, the CDR assesses people's memory and problem-solving skills as well as their ability to care for themselves.

Caregivers can be extremely helpful in identifying unsafe drivers -- but only if they're honest, Iverson says.

"If a caregiver says, 'I'm concerned,' or rates a patient's driving as 'marginal' or 'unsafe,' that really pans out," he says.

But studies show that caregivers who deem their loved one's driving as "safe" are rarely accurate, "probably because they are trying to protect the patient," Iverson says.

"And if a patient himself says their driving is fine, that doesn't help. In fact, the strongest evidence we found is that this doesn't correlate with safe driving," he says.

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