Driving and dementia
Roy Yaari, MD, is a neurologist, dementia specialist and director of the Memory Disorders Clinic at Banner Alzheimer’s Institute. His office can be reached at (602) 839-6900.
Question: My husband has been diagnosed with dementia. At what point should he stop driving?
Answer: Dementia is a progressive disease that affects memory and other cognitive proficiencies like spatial ability and perception. Since driving skills decline with disease progression, the point at which someone should stop driving depends on the severity of dementia. Identifying those who are unsafe drivers without restricting those who are safe requires understanding how dementia impacts driving and awareness of the warning signs.
Changes in judgment, forgetfulness, impulsiveness, difficulty multitasking and an inability to maintain focus are known symptoms of dementia. It is not uncommon for drivers with dementia to forget where they are going, get lost or even misjudge proximity to other vehicles, traffic lines, and where to turn.
Physicians assess a patient’s ability to drive safely by considering input from family/caregivers about driving habits and behaviors. Additionally, they evaluate results of cognitive tests, which measure visual spatial ability and memory. Severity of the disease as determined by cognitive testing also factors into analysis of driving safety. A patient’s feedback about their driving skills is not a reliable assessment tool.
Driving typically stops during the mild stage of dementia. Those rated as moderate or severe dementia should not drive.
Physicians begin discussing the eventual need to stop driving early in the care process. Cognitive testing, which is repeated at follow-up appointments, as well as family/caregiver input helps determine a patient’s driving risk. In addition, on-road driving tests may help further evaluate driving ability.
We encourage reasoning with patients to seek a peaceful resolution about not driving whenever possible. These conversations can be emotionally charged since driving is tied to independence. However, it is imperative that dementia patients and/or their family/caregivers understand the dangers of their diagnosis and the many liabilities associated with driving.
Seek cognitive testing if you notice signs of unsafe driving like unexplained dents or dings in the vehicle, incorrect signaling, inappropriate speed (too fast or too slow), delayed response, agitation toward other drivers, confusion between brake and accelerator pedals, or stopping in traffic. The costs of driving with dementia could be high.