Driving & Dementia

Millions of drivers may have a mild or other form of dementia.  Sometimes the symptoms are obvious.  Other times, they are not.  Drivers with dementia may not recognize the symptoms and, hence, may lack the ability to acknowledge that they have dementia and cease driving, if necessary.  This is a public health hazard that needs to be addressed:  Studies show that the incidence of dementia is expected to jump 400% over the next twenty years.¹  As people live longer and extend their mobility, more and more drivers may have symptoms of dementia and pose crash risks to themselves and other motorists.  Many dementia drivers, especially of the Alzheimer’s type, may continue to drive well into a disease that persists 8 to 10 years after the onset of symptoms.²  The recent verdict associated with the Santa Monica food market tragedy, where a driver with alleged cognitive impairment killed 10 people and injured more than 70 others, underscores the need for automated cognitive screening tools and driver's license test and policy reforms.

Although dementia, typically characterized by loss of cognitive function due to brain disease or trauma,  can occur at any age, the greatest risk factor is increasing age. ³  Alzheimer’s disease, the most common form of dementia, appears in nearly 10 percent of all people age 65 years and older and approximately 50 percent of all people age 85 years and older. ⁴

According to Carr et al.⁵,  some of the symptoms of unsafe driving may include:

• Crashes

• Dents on car

• Difficulty understanding traffic signs

• Driving too fast or too slow

• Failure to notice street signs

• Getting lost in familiar areas

• Indecent gestures or horn honking from other drivers

• Miscalculating speed and distances

• "Near misses"

• Poor judgment

• Tickets for traffic violations

• Tunnel vision

Land Transport New Zealand ⁶ recommends a quick sign test (also available through SpecialtyAutomated) and notes additional warnings that may be associated with the early signs of dementia :

• confusion when stopping and changing lanes
• ignoring traffic lights and signs — confusing the color or order of the lights or failing to notice traffic lights, Stop signs or Give Way (Yield) signs

In some places, such as Ontario, Canada, physicians are required by law to report patients who have medical conditions that may negatively impact their driving performances. ²  Yet, most physicians are not trained to detect dementia drivers or other at-risk drivers.  Most physicians may not know how to identify these diseases in their patients without the use of specialized equipment or actual driving observations.  Others may not want to risk liability or jeopardize the physician/ patient relationship when the subject of driving and dementia need to be addressed. ³  In the USA, licensing agencies usually review anonymous and signed tips that address concerns about a driver's ability to drive.

It is important to note that diagnosis of a neuropsychologic or neuromotor disorder does not imply driving impairment. ³   However, in some cases, these diseases, especially in advanced stages, may disallow the safe operation of motor vehicles. 

The Clock Drawing Test is one of two cognition tests recommended by the American Medical Association (AMA) and the National Highway Traffic Safety Administration (NHTSA) for conducting a driving evaluation.  Abnormal scores on the Clock Drawing Test are associated with an increased crash risk and may also indicate the need for  further evaluation.⁷  Clock drawing tests, uniquely,  measure  attention, executive function, memory, and visuospatial skills. ⁵

Periodic screening with rapid, validated, and computerized tests, such as the Automatic Clock Drawing Test , will ensure that all drivers are cognitively screened and those with symptoms may be monitored on an ongoing basis so they may continue to drive as long and as safely as possible. ⁸

While there are various stages and varieties of dementia, it is necessary to periodically test drivers because conventional testing methods and self-screening assessments may not easily detect this condition. ³   No driver's license division requires or offers automated cognitive screening tests.  The current methods of driver's license tests are inadequate and therefore require significant improvement.^{9, 10}

Although driving is a complex activity, it should never jeopardize the life of the driver or another motorist.  The decision to report, monitor, or revoke the driver's license of a dementia driver should involve family members, driver's license staff members, and the police.  Alternative methods of transportation should be discussed. 

To find out more about the Automatic Clock Drawing Tests ™, a complete line of automated traffic sign tests, and numerous brain fitness and healthy mind products, please view our list of products, our catalog, or contact us.

 

References

1 .    Whitmer, R.A.,, E. P. Gunderson, E. Barrett-Connor, C. P. Quesenberry Jr, K. Yaffe. 2005. “Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study.” British Medical Journal, doi:10.1136/bmj.38446.466238.E0  (published 29 April 2005). 2.    Hopkins, R. W., L. Kilik, D. J. A. Day, C. Rows, and H. Tseng. 2004. “Driving and Dementia in Ontario: A Quantitative Assessment of the Problem.” Canadian Journal of Psychiatry 49: 7: 434- 438. 3.     Straus, S. 2005. “New, Improved, Comprehensive and Automated Driver’s License Test and Vision Screening System”, Department of Transportation and Federal Highway Administration, FHWA-AZ-04-559(1). HTML. Sections. 4.     Evans, D.A., H. H. Funkenstein, and M. S. Albert. 1989. Prevalence of Alzheimer’s Disease in a Community Population of Older Persons: Higher than Previously Reported.  Journal of the American Medical Association 262:18: 2552 – 2556. 5.     Carr DB, Duchek JM, Meuser TM, Morris JC. 2006.  Older adult drivers with cognitive impairment.  Am Fam Physician. 2006 Mar 15;73(6):1029-34. 6.     Land Transport New Zealand. 2006. Factsheet 23- Dementia & Driving. 7.     American Medical Association (AMA), in conjunction with the National Highway Traffic Safety Administration. 2003.  Physician’s Guide to Assessing and Counseling Older Drivers. 8.      Straus, S. 2006.  "Improving Medical Care and Knowledge Through New and Rapid Automated Cognitive Impairment Screening Tools,"  Annals of Family Medicine, Electronic letter, Dec  2006. 9     Straus, S. 2005. “New, Improved, Comprehensive and Automated Driver’s License Test   and Vision Screening System”, Department of Transportation and Federal Highway Administration, FHWA-AZ-04-559(1), Research Note. 10.     Straus, S. 2005. “A Call for Transportation License Reforms”.  Presented to the United States Department of Transportation, Washington, DC, 28 September 2005.