As such, it is recommended to re-evaluate these patients with mild dementia every 3 to 6 months. Forty-five percent of drivers with CDR 0.5 to 1.0 passed on-road driving tests but showed a decline in function in 6 months. Patients with CDR > 1.0 should be assessed for driving safety, as this is the only screening test that carries level A evidence of utility. The most important factor is the severity of dementia, and this is typically assessed with the Clinical Dementia Rating(CDR) scale. Many organizations like the American Medical Association and the American Academy of Neurology have proposed guidelines for evaluating driving safety, and these parameters often involve specific screening variables. Often, collateral information from caretakers plays a key role in determining any concerns that the patient may not have noticed.Īssessing fitness to drive requires a multifactorial approach, and there is no single objective test or scale used for evaluation. Other symptoms that suggest a patient needs a driving assessment are changes in driving habits, such as preferring to take familiar roads only, minor vehicle accidents, and parking citations. Early communication about anticipated driving difficulties allows the patient and family to be more cognizant of functional decline. This suggests that even patients who report no problems with driving may have subtle impairment of driving skills and could benefit from driving fitness assessments. However, an analysis of this population of patients with a clinical dementia rating scale of 0.5-1.0 showed on-road testing failure in 13% of the participants. In fact, many patients with mild cognitive impairment and mild dementia still have the ability to operate a vehicle safely. ĭementia is a progressive illness, and not all patients with dementia experience the same deficits. Their motor reactivity may be slower, and their coordination and balance may also be impaired. Patients with visuospatial deficits may miscalculate distances or have difficulties with parking in small spaces. In addition to these functional cognitive deficiencies, patients with dementia often have neuropsychiatric symptoms, such as anxiety, paranoia, and lack of insight into their illness. Frontotemporal dementia may lead to an increase in aggressive, risk-taking driving. Deficits such as apraxia may impair their ability to execute tasks critical to driving, such as timely application of the brakes or steering away from obstructions on the road. Patients have greater difficulty integrating information to make complex executive decisions. Regardless of the type, neurocognitive disorders can cause deficits in attention, insight, and judgment. Analyses of errors made by drivers with dementia show significant difficulties with turning, lane positioning, and identifying traffic signs. Drivers with dementia are more likely to get lost or drive below the speed limit, which may result in road traffic accidents. The added complication of cognitive impairment makes driving an even greater challenge for patients with dementia. Elderly drivers, even without dementia, may find this multitasking difficult, as many are battling chronic medical illnesses, physical disabilities, and the compounded effects of polypharmacy. They must also be able to process the symbols on their dashboard and the buttons to operate the car while also paying attention to the signage on the road. Drivers must be able to understand new traffic patterns and react quickly to their surroundings. Unlike other activities of daily living, driving is unpredictable and requires attention to many simultaneous audiovisual inputs. Despite these barriers, driver safety assessment is an important public health and medicolegal issue and should be familiar to all healthcare professionals. The true extent of driving impairment may be minimized by caretakers who either do not want to admit the progression of their loved one’s disease or do not want to take on additional driving responsibilities. Driving is integral to a patient’s independence, so discussions of driving fitness may be met with emotional resistance, and patients may not recognize or admit their deficits. Physicians often do not get formal training on how to conduct these conversations and seldom know that they are qualified to make this assessment. ĭriving safety assessment is a sensitive discussion that is often delayed or forgone altogether because of physician reluctance, patient refusal, or caretaker preference. Patients with dementia have a two to eight times increased risk of motor vehicle accidents compared to similarly aged drivers without dementia, yet many are never counseled on driving safety. When caring for patients with dementia (PWD), it is important to feel comfortable assessing the patient’s fitness to drive.
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