Driving and dementia: a clinician's guide

Abstract

SummaryWith an ageing population and more drivers on the road, the number of drivers with dementia is due to grow exponentially over the next 50 years. Although decisions regarding possession of a driving licence in the UK are made by the Driver and Vehicle Licensing Agency (DVLA), psychiatrists have a duty to advise patients who are unfit to drive to cease driving and to inform the DVLA of patients who pose a risk to the public by continuing to drive when advised not to. This article offers a review of the literature on dementia and driving and summarises the evidence and advice for navigating this minefield. The use of psychological test batteries in clinical practice is discussed, along with the most useful questions to ask in memory clinics. Legal guidance for various countries is considered, as is the important (but often overlooked) issue of helping older people prepare for retirement from driving.

Inequity in health: older rural driving and dementia

“…Most available evidence pertain to Alzheimer's dementia, the general consensus being that it is usually safe to drive for about 3 years following onset of the disease 7–9. The rate of deterioration varies, with vascular dementia more likely to remain stable over time yet being more unpredictable, and frontotemporal and dementia with Lewy bodies (table 2) requiring earlier driving cessation 1…”

“…Cognition is perhaps the most difficult domain to assess, and screening tools such as the mini-mental status examination and the clinical dementia rating do not actually assess functions specific to driving ability 1. There is, in fact, no validated ‘doctor's room’ or ‘across-the-desk’ tool that reliably distinguishes between safe and unsafe drivers 20.…”

“…In the UK, Canada and a number of states in the USA and Australia, medical practitioners advise patients that they are no longer fit to drive; patients then have the responsibility to inform the Driver Licensing Authority (DLA) 1. In some jurisdictions, i it is mandatory for medical practitioners to report unfit drivers to the DLA,10 yet they are generally reluctant to do so owing to the negative effects this has on the doctor–patient relationship and adverse medical outcomes 23.…”

“…Most individuals with moderate-to-severe dementia (table 1) are unfit to drive 1. Drivers with moderate-to-severe dementia have higher rates of MVCs than age-matched controls 2.…”

“…The ability to drive is a critical means of maintaining one's social inclusion, and is commonly a practical necessity. Therefore, decisions about the entitlement to drive should not unfairly restrict mobility or unnecessarily compound the disadvantages experienced by older people with mild cognitive impairment and early dementia (table 1), particularly as diagnoses are now being made earlier 1…”