September 16, 2004
Men and women in the early stages of Alzheimer's may remain fit to drive a car, a new study shows, but subtle changes in perception and judgment may lead to accidents and injuries, particularly as the disease progresses. The findings underscore the need for caregivers and doctors to regularly assess driver competence for anyone with Alzheimer's disease.
Researchers from the University of Iowa gave on-road driving tests to 32 seniors with mild Alzheimer's disease. They were also given vision and judgment tests related to safe driving. Their results were compared with 136 seniors who did not have memory problems.
Overall, those seniors with mild Alzheimer's disease did not do as well on on-road driving tests. When given verbal directions for following a specific route, for example, they made more wrong turns and tended to get lost more often. They also made more safety errors, such as moving outside the borders of road lanes.
Many of the driving errors those with Alzheimer's made, however, were reasonably mild. Furthermore, the researchers note, "A number of drivers with Alzheimer's disease did not make turn errors, did not get lost, and drove safely, suggesting that some individuals with mild dementia remain fit drivers and should be allowed to continue to drive."
Getting lost is a common problem for anyone with Alzheimer's. Persons with the disease typically first begin to lose their way in unfamiliar surroundings but may do fine when near their homes. As the disease progresses, however, many become lost even in familiar places.
Like many other skills, the ability to drive often declines slowly for someone in the early stages of Alzheimer's, and deciding when it's time to give up the car keys can be difficult for any elderly person. Driving affords older people a coveted sense of independence and connection to the wider community at large. Taking away a license can be devastating to self-esteem and make life more difficult for seniors and family members both.
Dr. David Drachman, of the University of Massachusetts Medical School, recommends that an on-road driving test by an experienced instructor is the best measure to assess driving competence. However, it is possible that those with early Alzheimer's disease might find it more difficult to take a driving test based on "verbal instructions," so it is not absolutely clear that this type of exam would accurately predict safe or unsafe driving in some cases. Dr. Drachman also recommends that a family member ride with the person with Alzheimer's at least once a month. If the family member feels unsafe, then it's time for the person with Alzheimer's to turn in the car keys, he says.
Last year, the government, along with the American Medical Association, issued in-depth guidelines that doctors and caregivers can use to assess and instruct seniors on driving safety, including those with Alzheimer's. It is particularly important that family members look for any signs of mental decline in loved ones and discuss concerns with a physician, they note. Family members and doctors also need to counsel the patient to prepare him or her for stopping driving and get them to accept a "no driving" status. Among their recommendations:
Keep It Safe. 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.
Engage the Family. 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.
Perform Regular Assessments. 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. This specialist should be familiar with the symptoms and nature of Alzheimer's disease.
Provide 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 the www.ALZinfo.org to find help in your area.)
For more on Alzheimer's and driving safety, visit the Continuing Care portion of www.ALZinfo.org, "Driving and the Person with Alzheimer's Disease."
E.Y. Uc, MD; M. Rizzo, MD; S.W. Anderson, PhD., et al: "Driver route-following and safety errors in Alzheimer disease." Neurology 2004: 63: pages832-837.
David A. Drachman, MD: Safe Driving: Aging and Alzheimer Disease (commentary). Neurology 2004: 63: page 765.