New guidelines can help clinicians determine when a person with Alzheimer's disease or other forms of dementia should stop driving.
The new guidelines issued by the American Academy of Neurology were published in the April 12 online issue of the journal Neurology and were written by a team of specialist clinicians, including a neurologist with UI Health Care.
The team, which included senior author Matthew Rizzo, MD, UI professor of neurology, engineering and public policy, evaluated which tests and observations were most useful for predicting increased risk of unsafe driving among patients with dementia. The lead guideline author was Donald J. Iverson, MD, with the Humboldt Neurological Medical Group, Inc. in Eureka, CA.
Less Clear
"Although severe dementia significantly impairs driving skills, for patients with mild dementia, the situation is less clear cut," Rizzo said. "In fact, as many as three in four patients with mild dementia may be considered safe drivers based on their ability to pass an on-road driving test.
"With these uncertainties, as well as a concern that we not restrict driving for people who can still safely do so, we developed these guidelines to help clinicians identify which patients may be at higher risk of unsafe driving," Rizzo added.
The guidelines establish that a test known as the Clinical Dementia Rating scale is useful in identifying potentially unsafe drivers and recommends that clinicians use it. This tool allows clinicians to integrate information from caregivers and direct examination of patients to determine the severity of a patient's dementia. Conversely, the guidelines find that a patient's self-rating of safe driving ability is not a reliable indicator of safe driving ability.
Assessment
The guidelines also found that caregivers' concerns that a patient's driving had become "marginal" or "unsafe" were often accurate and should be part of the clinician's overall assessment of a patient's driving capability.
Warning signs of unsafe driving due to dementia that caregivers and family members might observe include:
- Decreased miles being driven
- Collisions
- Moving violations
- Avoiding certain driving situations, such as driving at night or in the rain
- Aggressive or impulsive personality traits
Rizzo noted that the new guidelines did not fully address a number of cognitive tests that currently are used to help assess driver safety. These include tests of memory, attention, decision-making and spatial ability. These issues will likely be addressed in future guidelines.
"Assessing a patient's driving skills is a complex process, and clinicians need to use multiple sources of information as they work with patients with dementia and their families to determine when to recommend that a patient stop driving," Rizzo said.
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