Driving Fitness in Different Forms of Dementia: An Update

Max Toepper, PhD; Michael Falkenstein, MD

Disclosures

J Am Geriatr Soc. 2019;67(10):2186-2192. 

In This Article

General Conclusions and Practical Implications

The current literature review entails different policy recommendations. In conclusion, fitness to drive in dementia depends on the severity and etiology of the respective dementia syndrome. In moderate and severe dementia, driving appears not to be possible anymore, irrespective of the type of dementia. In milder disease stages, the non-Alzheimer syndromes seem to pose a higher risk than ADD, particularly being reflected by higher on-road fail rates in VaD and PDD and a higher number of at-fault crashes since disease onset in FTD. Possible reasons may be that the non-Alzheimer syndromes are not only associated with driving-relevant cognitive deficits limiting driving fitness (ie, attentional and executive dysfunctions), but also with noncognitive symptoms, such as behavioral or motor disturbances, both of which can additionally reduce driving safety. In aMCI and in mild ADD, driving might still likely be possible.

In any case, driving fitness should be checked as early as possible in the disease process (ie, MCI) or shortly after diagnosis at the latest. Thereby, different measures and assessment strategies are required due to a great variety of driving error types between the different dementia syndromes.[9,39] The assessment should be multidisciplinary and multifactorial,[5,22,27,28,64–66] including an evaluation of specific risk factors that have been shown to be predictive of driving fitness in previous studies,[55,67] and with on-road testing, if possible. Importantly, demented drivers should be informed about disease-related risks for driving safety and the definite loss of driving fitness at some point in the course of the disease. If this does not happen, it can be considered a treatment error. In addition, it is highly important to always document the consultation, to prevent the physician from possible recourse claims by insurance companies in the event of an accident caused by the patient. If the assessment confirms fitness to drive in a demented patient, regular follow-up examinations at intervals of 6 to 12 months are indispensable due to the disease-related progression of cognitive deficits.[24,68] If, at some point in the future, these patients are no longer fit to drive, they should be sensitively supported as driving cessation is frequently associated with psychosocial problems, such as reduced mobility, autonomy, functionality, social participation, or mental health.[69–72] This support should also include the timely organization of possible transport alternatives. How all these recommendations can be best implemented is dependent on the specific habits and legislations in the respective states or countries. A risk evaluation for driving safety, depending on severity and type of different dementia syndromes is presented in Figure 1.

Figure 1.

Risk evaluation for driving safety depending on severity and type of different dementia syndromes. ADD indicates Alzheimer disease dementia; DLB, dementia with Lewy bodies; FTD, frontotemporal dementia; MCI, mild cognitive impairment; PDD, Parkinson disease dementia; VaD, vascular dementia.

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