A Guide for Caregivers

by Lisa Snyder

To drive or not to drive? That is a big question and one that will face every individual diagnosed with Alzheimer’s disease (AD) or a related memory disorder.

We frequently are asked questions about this complicated and controversial subject. While each situation may vary a bit, these are some general themes and concerns.

How does Alzheimer’s disease affect driving?

Symptoms of memory loss, disorientation, and changes in vision and perception may result in drivers getting lost, misjudging distances, forgetting the “rules of the road” or having slowed reaction times when making the multiple quick decisions needed to drive safely on the roadways. Concentration may be affected as well as coordination. Some memory-impaired people find that they are more easily frustrated in stressful situations. or, conversely, insight may be impacted such that individuals with AD are quite unaware of the safety hazards they may be posing to others due to their driving errors. All of these circumstances can affect driving performance and safety.

Do people with Alzheimer’s disease have more accidents?

Research findings in this area are not consistent. Some studies indicate that drivers with AD or related memory disorders are 4-8 times more likely to experience motor vehicle accidents. Others conclude that drivers in the early stages of AD have a slightly greater risk than most drivers but have a lower risk of accidents compared with young male drivers. Some findings suggest that the AD-diagnosed driver tends to get in more “fender-bender” types of accident rather than in major collisions. However, there are reported incidents of drivers killing pedestrians and/or other drivers due specifically to errors caused by their dementia. It is difficult to evaluate how many near misses are avoided by other drivers compensating for the errors made by the driver with AD (i.e. being forced to abruptly brake, needing to go around a person lingering in an intersection, having to yield inappropriately, etc.) Also, individuals with AD may give up driving prior to having an accident.

Will a driver’s license automatically be revoked due to a diagnosis of Alzheimer’s disease?

In some states, physicians are mandated by law to report a diagnosis of AD to the Health Department who then reports to the Department of Motor Vehicles (DMV). In other circumstances, concerned family or friends may make a report. The DMV may then review the driving and/or medical records of the diagnosed individual. In the case of a physician referral, the DMV will ask the physician to document any impressions of the person’s ability to continue driving.

The diagnosed person would then be sent a letter indicating the need for a driving evaluation.  At an appointed time, a written and driving test is administered. If the person passes, his/her license is renewed, sometimes with restrictions i.e., yearly re-evaluation or driving in a certain area only. If the person fails, the DMV usually gives an opportunity for re-examination, although this should be discouraged. Some diagnosed individuals report having good days and bad days and may want to try again on a “good day”. However, it is just this variation in ability that can create one of the hazards of driving with Alzheimer’s disease.

What are the signs of an unsafe driver?

While some individuals with Alzheimer’s disease show good insight into their abilities and limitations, others do not and will need to be evaluated more closely by family members, friends or professionals.  The following are some common areas of concern:

• Forgetting how to get to familiar places may be an indication of significant changes in memory or concentration.
• Misjudging distances (i.e., following too closely, turning too widely or narrowly) may be due to changes in vision or perception.
• Disregarding traffic signals, including running stop signs or red lights, or stopping at a green light.
• Poor decision making in traffic is common and includes not using turn signals, weaving across lanes, becoming confused at four-way intersections or not yielding to traffic when needed.
• Driving too slowly is common and may indicate changes in perception and judgment.
• Losing one’s temper or becoming easily frustrated is common enough on busy roads. However, the person with AD may also have an inability to process the multiple stimuli and demands of driving and as such, becomes more easily overwhelmed.

If a person with AD drives with a license and gets into an accident, can he/she be sued?

A driver’s license allows an individual to drive as long as there are no impairments that put them at risk of harming others. If a person diagnosed with AD is in an accident, it does not automatically mean he/she is legally responsible for the accident. It would have to be proven, by evidence that the impairment caused or contributed to the accident. However, if the disease progresses and obviously affects driving as previously discussed, and the diagnosed individual does not voluntarily seek re-testing for driving safety, or report for it if requested, this poses complications. Should the person then get into an accident, she/he could be charged with knowingly driving (or a family member charged with letting him/her drive) in a disabled condition that placed others at risk for injury. As such, even though a person has a license, it is essential to show a good faith effort to monitor the effects of AD on driving performance. It is strongly recommended, for legal and ethical purposes, to be voluntarily re-tested on a regular basis (i.e., every six months.) Please contact your local DMV or an attorney with specific questions on this issue.

What steps are being taken to better understand, evaluate and test the impact of AD on driving?

Researchers are continuing to study comparisons in the driving patterns of normal elderly controls and individuals with AD to better discern the specific impact of AD on driving. One frequent finding is that visual-perceptual and attention problems have the most impact on driving. Efforts are underway to create a more sensitive and specific battery of tests that will measure these impairments. This will enable physicians of the DMV to effectively identify a cut-off point when it is no longer safe for a person with AD to be driving.

It is clear that the evaluations performed by the DMV are not always effective in detecting the particular impairments of those diagnosed with AD. Investigations are underway to evaluate the effectiveness of driving simulators as a means at testing specific problematic scenarios. These would enable a person to be tested without the risk of placing an impaired driver on the road.