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When Should Dementia Patients Stop Driving?

American Academy of Neurology Offers Guidelines for Taking Away the Car Keys

Warning Signs of Driving Problems

The guidelines say these are some of the warning signs caregivers should watch for:

  • Accidents. Research shows that people who have had a crash in the past five years are more likely to have another accident, compared to people with mild dementia alone.
  • Moving violations. One study showed that people over 70 who had two or more tickets in the past three years were more likely to have a crash than any other age group, including teenage boys, who recently held that spot.
  • Driving less. "The magic number seems to be 60 miles a week. Driving less than that is associated with unsafe driving," although where you live and how frequently you typically drive factor in, Iverson says.
  • Avoiding certain driving situations, such as driving at night or in the rain.
  • Road rage. Research shows that aggressive or impulsive personality traits can be useful in identifying unsafe drivers, Iverson says.

Becoming lost on a familiar route may also be a warning sign, says David Knopman, MD, a spokesman for AAN who was not involved in writing the guidelines.

Getting lost once may mean nothing, he says. "But if a person arrives two hours late repeatedly with no good explanation or there are unexpected dents in the car, there may a problem, says Knopman, a neurologist at the Mayo Clinic in Rochester, Minn.

Caregivers and Doctors Take Charge

So is there anything a person with dementia can do to improve his or her driving skills?

Not really, Iverson says. One study showed that people over 85 who took an in-person test to renew their driving license slightly lowered their risk of being in a deadly crash. But otherwise there was no evidence supporting strategies such as driver training or licensing restrictions, Iverson says.

The bottom line, he says, is that even as dementia worsens, most patients are going to deny that they pose a hazard on the road. That places doctors and caregivers in charge.

Don't bring up giving up the car keys when a person is just recovering from the blow of being diagnosed with dementia, Iverson says.

"But over time, caregivers and doctors should begin the discussion," he says. "It's a process. And, it's not easy."

Doctors, patients, and caregivers must also know their state laws, because some states require that doctors report any medical conditions that may affect a patient's ability to drive safely.

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