January 30, 2004
The decision to stop driving is never easy for families touched by Alzheimer's or other forms of mental decline. But, when do you decide it's time to turn in the car keys? A new analysis reveals that health-care professionals can be an important part of that decision.
Researchers led by psychologist Mark Reger, Ph.D., of the University of Washington School of Medicine, analyzed 27 different studies on driving and dementia published during the past 25 years. Their conclusion: On-the-road or off-road simulator driving tests in people suffering from the early stages of Alzheimer's were a more accurate indicator of driving skills than assessments by patients or caregivers.
Mental impairment during the middle to late stages of Alzheimer's often clearly precludes driving or other complex tasks. During the early stages of the disease, though, it is not always clear when somebody should stop driving. Those with declining mental abilities may think their driving is fine and not worry about it, while those who care for them may feel just the opposite.
The researchers found that tests that measured a person's visual and spatial skills were better than caregiver's assessments at judging driving ability. For the early stages of Alzheimer's, visual and spatial skills were more important than other cognitive skills, such as concentration and attention, general thinking abilities, memory, and language.
The findings, published in the January 2004 issue of Neuropsychology, published by the American Psychological Association (APA), underline the importance of getting professional help when dealing with difficult problems like driving and dementia.
"Although visuospatial deficits alone are not sufficient to recommend driving restrictions, the results indicate that when visuospatial deficits are present, clinicians should complete a careful evaluation of other risk factors," the researchers stated. Problems with vision and spatial skills, they concluded, are a red flag to look for other problems.
At the same time, a person whose visual skills are not impaired but who does have memory problems could nevertheless be at risk for becoming lost. In such instances confusion can result, and that could spell trouble in a driving situation. That's why it's important to include the physician in decisions concerning driving restrictions. It is also important to remember that Alzheimer's is a progressive disease. Evaluation of driving skills must be updated on a regular basis to account for inevitable declines.
The American Medical Association and the National Highway Traffic Safety Administration recently issued guidelines on safety and older drivers. Among their recommendations for those with Alzheimer's:
* Safety First. Some drivers in the early stages of Alzheimer's may be competent to drive, even if they have been diagnosed with dementia. The decision whether to impose a driving ban should depend on a careful assessment of a driver's ability. If a driver poses a threat to himself or others, a ban must be imposed.
* Detailed Assessment. Family members should provide the doctor with detailed information about any problems relating to driving as well as memory, judgment, attention and visual and spatial abilities. When appropriate, patients should be included in decisions about current or future driving restrictions.
* Ongoing Testing. Doctors should perform thorough and regular exams to assess the patient's skills and abilities and conform to state and local restrictions and laws. A driver rehab specialist can conduct an on-road driving test of an older person with impaired mental functions to assess his or her abilities to continue driving.
* Transportation Alternatives. Physicians and family members should plan early for those with progressive dementia to use public transport and alternative transportation options, such as buses, taxis, trains, senior shuttles, and rides from family and friends. Your local area Agency on Aging may also be able to help. [See www.ALZinfo.org to find help in your area.]