Cognitive impairment, dementia, and driving
Changes in cognition don’t necessarily mean the end for driving. People in the earliest stages of mild cognitive impairment, dementia, and even Alzheimer’s disease may be able to continue driving for some time. It can be tricky to determine exactly when that becomes dangerous. This article discusses how to prepare for changes in your loved one’s driving ability as their mind changes, and how to keep them and others safe.
Mild cognitive impairment (MCI)
Mild cognitive impairment, according to the Mayo clinic, is “the state between the expected decline in memory and thinking that happens with age and the more serious decline of dementia.”1 It is more than the usual forgetfulness and fogginess that comes with natural aging, but falls short of dementia. People with mild cognitive impairment have difficulty concentrating and making decisions and frequently have memory problems.2 But unlike Alzheimer’s disease and other forms of dementia, MCI is not always progressive, and many drivers with MCI are perfectly safe on the road. Closely monitoring a driver’s activities and road safety is important. Working with a driver’s doctor to keep up to date on changes in behavior and mental processing is also crucial, as each person experiences MCI differently.
Unfortunately, unlike MCI, Alzheimer’s disease and other forms of dementia are almost universally progressive diseases that degrade a person’s memory, judgment, and motor skills. This can, however, take place over the course of several years. Many people in the earliest stages of dementia are perfectly safe behind the wheel. That said, the American Academy of Neurology does recommend that people with mild dementia strongly consider giving up driving.3 As dementia progresses, many drivers are unable to accurately assess their driving ability.
A dementia diagnosis does allow for the ability to plan for the future. Due to the degenerative, progressive nature of the disease, a person with dementia will eventually lose the ability to drive. Even without a formal diagnosis, if someone is showing obvious signs of cognitive impairment, poor judgment, significant memory loss, or other factors that might impede driving, you’ll want to be prepared for the worsening of symptoms. By planning for that ahead of time, you can make the transition away from driving a bit easier. If the person is still able to make informed decisions, work with them on a plan to turn over driving responsibility, as well as a set of landmarks for decision-making.
Consider a driving contract
A driving contract acknowledges that the driver recognizes that they may not realize when it is time to give up driving. The driver designates one or more people to step in and make the decision for them. The contract also gives these representatives the power to take further action, up to and including removing the keys and/or vehicle from the driver, and reporting the driver to state or local authorities.4
Consider a driving evaluation
AARP offers several free online road rules quizzes, as well as a full Smart Driver online course for older adults.5 More formally, an occupational therapist or driving instructor may be able to provide a ride-along written assessment. These may report to the department of motor vehicles, though, so be sure you’re prepared to make changes to a person’s driving habits if the evaluator finds serious safety concerns. Check your local regulations for reporting and evaluating driving abilities.
Check state requirements
State laws vary in regards to drivers with Alzheimer’s diagnoses. In some states, a diagnosis of Alzheimer’s requires doctors to notify the department of motor vehicles. Other states impose mandatory testing or evaluation for anyone diagnosed with dementia, or anyone over a certain age.
Check in often
Cognitive impairment, dementia, and Alzheimer’s disease present differently in each person. As the disease progresses, new benchmarks will emerge. Sometimes change happens gradually, and sometimes very suddenly, so make sure to check in with a person’s physician and other people who can help you assess the driver’s ability or whether it’s time to arrange for alternative transportation options.
Arranging for and conducting a formal driving assessment
Curtailing unsafe driving habits
Getting help with an unsafe driver
Modifying driving habits of older adults
Physically limiting vehicle access for unsafe drivers
Reviewing driving regulations and legal risks
Unsafe driving warning signs