Can people with dementia drive? Dementia is burgeoning worldwide. The number of dementia sufferers is projected to increase exponentially as the world population ages. Yet transportation and mobility are key issues for the aged. How can the two-driving and dementia-be reconciled?

In most developed countries, privately owned vehicles are the main mode of transportation. Public transportation is seen as a far less desirable choice. Limited schedules and distant pick-up points can turn simple trips into day-long journeys. This can be taxing on an elderly person. What's more, the difficulty of entrance and egress on public transportation add to the challenges for the elderly.

So, as our parents age (or we age!), we ask "Can people with dementia drive?".An Australian study by Carmody and others showed that, in that developed country, people over the age of 65 had the fewest accidents of any age group per annum. That could be heartening news for the elderly who wish to maintain and operate private vehicles. A cautionary note is that, when someone over 65 is injured in a car crash, that person does not recover as easily as a younger person, and crashes more often result in fatalities.

An Australian study by Carmody and others showed that, in that developed country, people over the age of 65 had the fewest accidents of any age group per annum. That could be heartening news for the elderly who wish to maintain and operate private vehicles. A cautionary note is that, when someone over 65 is injured in a car crash, that person does not recover as easily as a younger person, and crashes more often result in fatalities. Let's examine the factors to be considered in answering the question "Can people with dementia drive?".

Early Dementia and Very Mild Alzheimer's Sufferers Can Drive Safely

The Australian researchers cited studies that showed that people in the early stages of dementia are still capable of driving well. Their recommendations were the same as those of the American Academy of Neurology. Those recommendations are that drivers with very mild or beginning dementia, including Alzheimer's, may be safe drivers, but that their licenses and driving abilities should be reviewed every six months.

A study of Alzheimer's patients in the early stages was done by Cutchett, Carr, and others. In this study, just 14% of drivers with very mild Alzheimer's failed a driving test. However, nearly half of drivers with mild Alzheimer's type failed. Over time, the greatest decline in driving performance occurred in the mild Alzheimer's group. It should be noted, then, that driving skills may decline quite rapidly during the mild stage.

Aging itself predicts less safe driving. Even within a group of healthy controls-that is, people who had no diagnosis of dementia of any sort-increasing age itself correlated with unsafe driving in the study cited above. Declining vision decreased motor skills, less psychomotor speed, and sheer physical weakness (in the hands, for example) all can impair driving for elderly people.

Mild Alzheimer's Sufferers' Driving Declined Most Rapidly

The researchers found that decline in driving abilities was slowest in those without dementia diagnoses. The decline was quicker in very mild Alzheimer's patients and even quicker in mild Alzheimer's cases. Two years after the beginning of the test, almost all drivers with Alzheimer's were in the unsafe category. The researchers noted that most people who receive a diagnosis of Alzheimer's stop driving within three years, presumably because they or caregivers notice a decline in driving skills. It appears, from the research, that this self-restricting or restriction by caregivers should probably come a year earlier.

In defiance of the statistics, some people with dementia and mild Alzheimer's were still safe drivers. Therefore, blanket restrictions on all people with dementia are inappropriate. The six-month monitoring recommendations of the AAN seem consistent with these findings: that individuals within a diagnosis group differ in driving abilities.

Can People with Dementia Drive?

Since older people need and treasure the mobility and options driving offers them, it is important for society to accurately assess when dementia and other results of aging render a person unsafe to drive. Calibrated and nuanced testing holds more promise of being both fair and safe than blanket restrictions on certain age groups or those who have a diagnosis of early or mild or very mild dementia, including Alzheimer's. So when you ask "Can People with Dementia Drive?", the answer is "it depends".

Sources

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American Academy of Neurology. (April 12, 2010). Practice Parameter update: Evaluation and management of driving risk in dementia Report of the Quality Standards Subcommittee of the American Academy of Neurology. Iverson, D. J., Gronseth, G.S., Reger, M.S. Classen, S., Dubinsky, R.M. Rizzo, M.
Available online at http://www.neurology.org/content/early/2010/04/12/WNL.0b013e3181da3b0f.full.pdf. Accessed April 7, 2017.

Carmody, J., Traynor, V., Iverson, D. C., Marcetti, E. M. (2013). Driving, dementia, and Australian physicians: primum no nocere? Internal Medicine Journal, 43(6): 625-630. Available online at: http://ro.uow.edu.au/cgi/viewcontent.cgi?article=1216&context=sspapers. Accessed April 7, 2017.

Duchek, J.M., Carr, D. B., Hunt, L., Roe, C., Xiong, C. et al. (2003). Longitudinal Driving Performance in Early-Stage Dementia of the Alzheimer Type. JAGS (Journal of the American Geriatrics Society) 51:1342-1347. Available online at: https://www.researchgate.net/profile/John_Morris7/publication/227742758_Longitudinal_Driving_Performance_in_Early-Stage_Dementia_of_the_Alzheimer_Type/links/0a85e5303704ac94c9000000/Longitudinal-Driving-Performance-in-Early-Stage-Dementia-of-the-Alzheimer-Type.pdf. Accessed April 7, 2017.

Reger, M. A., Welsh, R. K., Watson, G. S., Cholerton, B., Baker, L. D., Craft, S. (2004). The Relationship Between Neuropsychological Functioning and Driving Ability in Dementia: A Meta-Analysis. Neuropsychology In the Public Domain, 18(1) 85-93. DOI: 10.1037/0894-4105.18.1.85, Available online at:
http://www.apa.org/pubs/journals/releases/neu-18185.pdf. Accessed April 7, 2017.

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