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Driving with Dementia

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I was at an event this past week and had a conversation with an attendee about her parent and driving, but it was more than just aging and driving.  It was about her parent and their cognitive decline and the ability to competently get behind the wheel.  It’s complicated.

I have talked before about the different types of dementia and how they all have an effect on an individual’s ability to cognitively process what they experience into memories and even react to situations in real time.  Each of the major types of dementia – Alzheimer’s, vascular, frontotemporal, Lewy body and Parkinsonian – also has a different kind of impact on one’s ability to drive.  But it also has to do with the degree to which a dementia has progressed.  As soon as the doctors use words like “moderate” or “severe” the ability to drive safely is pretty much out of the question no matter what kind of dementia it is that affects your loved one. One of the more telling statistics on the effect of dementia on driving capabilities is that accidents are almost twice as likely in dementia patients versus healthy individuals in the three years prior to diagnosis.

Starting with the most hazardous diagnosis, it gets a bit more complicated with Parkinsonian patients with dementia because the motor as well as cognitive functions of these patients are affected.  While the data are relatively sparse, it appears that more than 80% of these very mild to mild dementia patients cannot pass a driving test.

In vascular dementia (owing to strokes) 70% patients with very mild to mild diagnoses fail a driving competency test compared with 11% of same age, but healthy adults.  The risk increases with more strokes even moving from just the first stroke to a second event.  Even “mini-strokes”, often referred to as transient ischemic attacks (TIAs) can cause this driving impairment.

Frontotemporal dementia patients are only slightly less driving-impaired than vascular patient.  About 50 – 60% of these patients who are categorized as very mild to mild will fail an on-road test.

Alzheimer’s disease drivers particularly have difficulty remembering directions, routes or landmarks, but they also misjudge distances and are slower to react to conditions.  It’s about their inability to orient themselves in real time that makes them a risk to themselves and to other drivers.  About 55% do not pass a driving test.

Dementia with Lewy bodies shows a typical fail rate among very mild to mild patients of 35 – 40%.  In simulator tests, however, Lewy body patients show a higher rate of collisions in testing.

So, you can see that it is a matter of degree when it comes to driving, and when an older loved one progresses to moderate or severe dementia, no one should drive.  The real takeaway here is that if you have an older loved one with even early stage dementia of any sort, they should be tested for their ability to drive…or maybe just for whatever constraints should be in place to assure a safe driving experience.  And as a loved one sees these limitations on “their freedom,” be sensitive to all the other limitations they may be facing in their day to day lives.  With the potential for depression looming always, be sensitive to how you communicate and do all that you can to support their sense of self-worth and independence.

To get ahead of the curve with your loved one, AARP offers driver safety course at locations throughout the region; please check it out.

Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.

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