Driving cessation in patients attending a memory clinic

Talbot, Ana; Bruce, Irene; Cunningham, Conal; Coen, Robert F.; Lawlor, Brian A.; Coakley, Davis; Walsh, J. B.; O’Neill, Desmond

doi:10.1093/ageing/afi090

Cited by 41 publications

(38 citation statements)

References 30 publications

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“…In particular, older age and greater impairment in cognition and function predicted driving cessation in our study. These findings are consistent with those focused on people with dementia, which have similarly found that older age and lower cognition and function predict driving status [17,30,31,32]. …”

Section: Discussionsupporting

confidence: 91%

“…This study, however, was limited by its cross-sectional design and small sample. Another study found a relationship between older age and driving cessation, but did not distinguish between MCI and dementia in its analyses [17]. Other research has found a relationship between poorer cognition and driving in older people [18,19], though did not specifically assess this relationship in people with MCI.…”

Section: Introductionmentioning

confidence: 99%

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Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Connors

Ames

Woodward

et al. 2017

Dement Geriatr Cogn Disord

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Background/Aims: Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this. Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI. Methods: One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period. Results: Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis. Conclusion: A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics - such as age, cognition, and function - and changes in these measures over 6 months predict driving cessation.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Connors

Ames

Woodward

et al. 2017

Dement Geriatr Cogn Disord

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“…COSID findings confirmed the associations previously documented of driving cessation with disease severity, increasing cognitive impairment and age. [4][5][6][7]9 These same factors have also been shown to increase the risk of motor-vehicle collisions in people with dementia. 10 Male gender has been associated with a higher risk of crashes and moving violations; 22 it is notable that at baseline, we found women to be significantly likelier than men to have already quit driving.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective study of 430 patients at a memory clinic, age, an urban dwellingplace, level of cognitive function and relative ability to perform the activities of daily living were found to be predictive of driving cessation. 7 Similarly, in a small prospective study of 53 patients with dementia, age and Mini-Mental State Examination (MMSE) 8 score predicted driving cessation over the next 2-3 years. 9 Determination of the factors associated with driving cessation is important, given the well-documented association between the risk of being involved in a motorvehicle collision and the severity and duration of the dementia.…”

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confidence: 99%

Predictors of driving cessation in mild-to-moderate dementia

Herrmann¹

2006

Canadian Medical Association Journal

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A landmark study of the epidemiology of dementia, the Canadian Study on Health and Aging (CSHA) determined that in 1992, some 316 500 Canadians over the age of 65 years (1 in 13) had dementia, with the risk of the disease doubling for every 5 years of age after 65.1,2 With the increasing mean age of our population, it is estimated that 500 000 Canadians will have dementia by 2021, and 750 000 by 2031.3 Although incidents involving drivers affected by dementia frequently make the headlines in the lay press, there is surprisingly little data on the factors in dementia that may be associated with driving cessation. In a cross-sectional study of community-dwelling subjects, Foley and colleagues 4 found that 46% of those whose dementia was rated as questionable (i.e., with a Clinical Dementia Rating 5 [CDR] of 0.5) and 22%, as mild (CDR 1) were still driving. Indeed, Duchek and associates 6 found that of patients who passed an on-road test at baseline, only about 20% of those with questionable dementia and none of those with mild dementia passed another road test 2 years later. In a retrospective study of 430 patients at a memory clinic, age, an urban dwellingplace, level of cognitive function and relative ability to perform the activities of daily living were found to be predictive of driving cessation.7 Similarly, in a small prospective study of 53 patients with dementia, age and Mini-Mental State Examination (MMSE) 8 score predicted driving cessation over the next 2-3 years.9 Determination of the factors associated with driving cessation is important, given the well-documented association between the risk of being involved in a motorvehicle collision and the severity and duration of the dementia. 10Clinical practice guidelines have not been consistently helpful in providing physicians with guidance related to driving and dementia. For example, although the conclusions of the Canadian Consensus Conference on Dementia 3 emphasized the need to assess patients with dementia for fitness to drive and provided suggestions for factors requiring evaluation (e.g., cognition, function, medical status, medication review), there did not provide specific guidelines for how to determine when driving cessation was necessary. In contrast, the American Academy of Neurology practice parameter for risk of driving in cases of Alzheimer's disease 11 provides much clearer recommendations for driving cessation, based on CDRs. Unfortunately, most primary care physicians are unfamiliar with CDRs and may have difficulty using athe ratings in everyday practice. The guide published by the Canadian Medical Association 12 quotes the National Safety Code, which has suggested that patients whose MMSE score is less than 24 are ineligible to hold a driver's license unless they have undergone a complete neurologic assessment. Unfortu- Predictors of driving cessation in mild-to-moderate dementiaBackground: Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementi...

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“…Concerning the effect of DAT on crash risk, certain studies have found a higher crash risk [18][19][20][21][22][23][24] , while others have not [25][26][27] . A higher crash risk is probably not found systematically because people suffering from DAT often limit or even stop driving altogether [19,26,28] , these restrictions increasing with the severity of the disease [29][30][31] .…”

Section: Introductionmentioning

confidence: 99%

The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging

Lafont

Marin-Lamellet

Paire‐Ficout

et al. 2010

Dement Geriatr Cogn Disord

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Aims: Our purpose was to identify cognitive tools associated with unsafe driving among elderly drivers of varying cognitive levels. Methods: Twenty drivers with early-stage dementia of the Alzheimer type and 56 nondemented drivers aged 65–85 were recruited. Various cognitive processes were measured and unsafe driving was evaluated during an in-traffic road test with 3 different indicators and a composite indicator. Results: The Wechsler Digit Symbol Substitution Test score was the best cognitive measure to detect unsafe drivers using the composite driving indicator. Conclusion: The Digit Symbol Substitution Test may be used by physicians for the evaluation and follow-up of older patients, with or without Alzheimer-type dementia, as a screening tool of unsafe driving.

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Driving cessation in patients attending a memory clinic

Abstract: Driving cessation was affected not only by psychometric performance but also by demographic and personal factors.

Cited by 41 publications

References 30 publications

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Predictors of driving cessation in mild-to-moderate dementia

The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging

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