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The Driving and Car Key Dilemma of Alzheimer’s Disease

Men and women in the early stages of Alzheimer’s disease may be able to continue driving for a time, but subtle changes in a driver’s self-awareness may lead to accidents and injuries, according to a new study. The findings underscore the need for relatives, caregivers and doctors to regularly assess driver competence for anyone with Alzheimer’s disease, memory or thinking deficits, or other signs of dementia.

For the study, researchers in France looked at real-life driving skills in 20 men and women in the early stages of Alzheimer’s. They compared them with 21 healthy older adults who were not suffering from memory or thinking deficits or other signs of dementia.

The researchers placed a video recorder behind the rear-view mirror of each driver’s car. Two expert psychologists then assessed their driving performance using a rating scale for safe driving.

The experts looked in particular at each driver’s ability to regulate their own behavior behind the wheel. Skills they assessed including the driver’s capacity to adapt their driving speed, to drive behind other vehicles at safe distances, to change lanes safely, and to anticipate or plan driving actions. They also recorded any accidents or near-accidents on the road.

Compared to the healthy older drivers, those with early Alzheimer’s disease were less able to adapt their driving speed to road and traffic conditions. They were also less likely to drive at safe distances, to change lanes safely and anticipate other drivers’ action.

Those with Alzheimer’s also had twice as many accidents or near accidents. In two thirds of such events, the driver with Alzheimer’s was considered “unaware” of the situation and had no clear reaction during the time of the accident or near accident. The findings were published in the Journal of Alzheimer’s Disease.

Although the study was small, involving only a few dozen drivers, such “real life” on-the-road studies are expensive to carry out and typically small. The findings underscore the need for caregivers to pay careful attention to a loved one with Alzheimer’s driving skills, since those with dementia are so unaware of their own abilities.

The researchers point out that future technologies in cars could help drivers with cognitive deficits more safely drive on the road. Such devices could, for example, alert drivers that they are not maintaining a safe distance from vehicles in front of them or help them to change lanes more safely.

Earlier studies have underscored the driving challenges faced by people with Alzheimer’s. Such studies have shown, for example, that those with dementia were less able to follow directions for a specific route, made more wrong turns, tended to get lost more often, and made for safety errors, such as moving outside the borders of road lanes.

But giving up the car keys is a fraught situation for anyone with early Alzheimer’s, and experts point out that many of those with mild disease remain fit drivers and may be allowed to continue to drive for a time. 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.

Experts advise 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 likely time for the person with Alzheimer’s to turn in the car keys.

Family members should also look for any signs of mental decline in loved ones and discuss concerns with a physician. Caregivers 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.

General recommendations include:

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. Chose off-peak times to drive and avoid fast speed highways and routes.

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.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: Paire-Ficout L, Lafont S, Coquillat A, et al: Naturalistic Driving Study Investigating Self-Regulation Behavior in Early Alzheimer’s Disease: A Pilot Study. Journal of Alzheimer’s Disease, Vol. 63, pages 1499-1508, July 2018

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