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Driving with Mild Dementia: How Safe Is It?

by Eric Butterman

If someone is diagnosed with early-stage dementia, does that mean his or her driving days are immediately over? Not necessarily, say new U.K. guidelines that address driving with dementia.

According to the guidelines, dementia can reduce a variety of abilities that affect driving, including the ability to:

  • Anticipate and react quickly and consistently to the actions of other drivers
  • Pay close attention to the road (traffic signals, road signs, lane markers, other vehicles, cyclists, and pedestrians)
  • Assess the speed and distance of other vehicles
  • Take proper action to avoid accidents
  • Respond to unexpected changes on the road like street closures, lane changes, and detours and road hazards
  • Plan and remember routes

If, however, those abilities are intact, driving allows people with early-stage dementia to remain active and connected to the community and to maintain a significant degree of independence. As dementia progresses, memory, spatial orientation, and cognitive function will eventually decrease to a point where driving becomes dangerous. But deciding when a person whose dementia is still only mild should stop driving is a challenging issue with no clear-cut answer.

Help from caregivers

In 2010, the American Academy of Neurology (AAN) released guidelines to help establish when people with dementia should stop driving. Like the U.K. guidelines, the AAN says that doctors should listen to what caregivers have to say. Caregivers are often the first to notice unsafe driving in a person with dementia. They’re more likely than the patient to give a realistic assessment of the patient’s driving abilities.

When there’s cause for concern, a doctor can evaluate dementia patients to see whether the disease has progressed. The doctor also assesses the ability to respond appropriately to visual cues, such as another car, a stop sign, or a mailbox. The AAN recommends that doctors assess thinking ability using a test called the Clinical Dementia Rating scale, which measures several brain functions such as memory, judgment, and problem-solving. Doctors should also consider a history of traffic citations or crashes, reduced driving mileage, aggressive or impulsive personality characteristics, and other factors that can indicate increased risk for unsafe driving.

Consider a road test

One measure of driving ability is a driving test. If a doctor has doubts about a patient’s fitness to drive, he or she might make a referral for a governmental or professional road test. Because dementia gets worse over time, some experts recommend testing every six to nine months, which can be costly and time-consuming.

An occupational therapy driving specialist can also administer a comprehensive driving evaluation. A therapist can identify any physical, visual, or cognitive challenges and assess the ability to drive safely. He or she can also recommend strategies for safer driving during early-stage dementia. You can find a local therapist by visiting the American Occupational Therapy Association website.

Department of Motor Vehicle (DMV) policies regarding drivers with dementia vary from state to state. Some states, like California, New Jersey, and Pennsylvania, require doctors to report to the DMV persons with a medical disorder or impairment, such as dementia or epilepsy, that could affect driving. The DMV may require such patients to undergo a road test.

12 Warning Signs It's Time to Stop Driving

Dementia can reduce a variety of abilities that affect driving. Here are some signs it’s time for you or a family member to hand over your car keys.

Cutting back on drive time

If you have mild dementia and your doctor says it’s safe for you to drive, try to limit your time on the road by, for instance, taking short daytime rides on familiar local streets instead of highways. Avoid driving under poor weather conditions, if you feel tired or unwell, or if you drink alcohol.

Now is the best time to prepare for when the day comes that you’ll no longer be able to drive safely. Plan with family members for a gradual reduction in driving. Research public transportation in your area, and keep in mind that many places of worship, rotary clubs, community centers, and assisted-living facilities coordinate carpools.

If a family member isn’t fit to drive, it can be a difficult topic to broach. People with dementia may forget they were told not to drive or not agree with the assessment that they’re unfit to drive. Beginning discussions about driving early on, reducing the need to drive, and arranging alternative transportation can help make for a smoother transition to life after driving.

This article first appeared in the March 2019 issue of UC Berkeley Health After 50.

Also see Night Vision Problems and Driving.