Abstract
Objective:To examine the driving status of Alzheimer’s disease (AD) patients presenting to a geriatric clinic, and to investigate the ability of brief cognitive assessment measures to identify those who are no longer able to continue driving safely.
Design:Based on caregivers’ reports of driving status, AD patients were divided into three groups: those who were still driving with no difficulty, those still driving but having difficulty, and those who had stopped driving due to their cognitive problems. Scores on commonly used cognitive tests were compared across groups. Age, gender, and duration of dementia were also investigated.
Setting:The University of Washington Medical Center (UWMC) outpatient Geriatric and Family Services Clinic.
Participants:One hundred consecutive patients who met DSM-III-R criteria for primary degenerative dementia and were either currently driving or had stopped driving due to cognitive deficits.
Measurement and main results:Twenty-two subjects were reportedly still driving with no difficulty, 23 were still driving with difficulty, and 55 were no longer driving. Both mental status screening and functional assessments were significantly different between drivers and nondrivers, as were scores on a visual-spatial task. In addition, gender and age distinguished the groups: younger drivers and men drivers were less likely to stop driving despite significant cognitive impairment.
Conclusions:Given the large number of AD patients who continue to drive and who experience problems with driving, this investigation highlights the need for assessment of driving safety as part of a clinical dementia evaluation. In addition, the results suggest a combination of cognitive and functional measures that may be helpful in identifying patients who are at greatest risk for unsafe driving.
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References
Drachman DA. Who may drive? Who may not? Who shall decide [editorial]? Ann Neurol. 1988;24:787–8.
Donnelly E, Karlinsky H. The impact of Alzheimer’s disease on driving ability: a review. J Geriatr Psychiatry Neurol. 1990;3:67–72.
Oliver CM. Driving and dementia. N Z Med J. 1991;104:288–9.
Scholz J, Colsher P, Wallace R. Independence in driving and social participation among rural elders. Gerontologist. 1990;30:235.
Friedland RP, Koss E, Kumar A, et al. Motor vehicle crashes in dementia of the Alzheimer’s type. Ann Neurol. 1988;24:782–6.
Gilley DW, Wilson RS, Bennett DA, et al. Cessation of driving and unsafe motor vehicle operation by dementia patients. Arch Intern Med. 1991;151:941–6.
Lucas-Blaustein MJ, Filipp L, Dugan C, Tune L. Driving in patients with dementia. J Am Geriatr Soc. 1988;36:1087–91.
Carr D, Jackson T, Alguire P. Characteristics of an elderly driving population referred to a geriatric assessment center. J Am Geriatr Soc. 1990;38:1145–50.
Galski T, Ehle HT, Bruno RL. An assessment of measures to predict the outcome of driving evaluations in patients with cerebral damage. Am J Occup Ther. 1990;4:709–13.
Jin HQ, Araki S, Wu XK, Zhang YW, Yokoyama K. Psychological performance of accident-prone automobile drivers in China: a case-control study. Int J Epidemiol. 1991;20:230–3.
Priddy DA, Johnson P. Driving after a severe head injury. Brain Inj. 1990;4:267–72.
Sivak M, Olson PL, Kewman DG, Won H, Henson DL. Driving and perceptual/cognitive skills: behavioral consequences of brain damage. Arch Phys Med Rehabil. 1981;62:476–83.
Van Zomerman AH, Brouwer AH, Minderhoud JM. Acquired brain damage and driving: a review. Arch Phys Med Rehabil. 1987;68:697–705.
Owsley C, Ball K, Sloane ME, Roenker DL, Bruni JR. Visual/cognitive correlates of vehicle accidents in older drivers. Psychol Aging. 1991;6:403–15.
Reuben DB, Silliman RA, Traines M. The aging driver: medicine, policy, and ethics. J Am Geriatr Soc. 1988;36:1135–42.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, third edition, revised. Washington, DC: American Psychiatric Association, 1987.
Reifler BV, Larson E, Teri L. An outpatient geriatric psychiatry assessment and treatment service. Clin Geriatr Med. 1987;3:203–9.
Teri L, Logsdon RG. Neuropsychological investigation of dementia of the Alzheimer’s type. In: Miner GD, Richter RW, Blass JP, Valentine L, Winters-Miner LA (eds). Familial Alzheimer’s disease: molecular genetics and clinical perspectives. New York: Marcel Dekker, 1989;31–44.
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
Mattis S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellack L, Karasu TB (eds). Geriatric psychiatry: a handbook for psychiatrists and primary care physicians. New York: Grune & Stratton, 1976;77–121.
Wechsler D. Wechsler Adult Intelligence Scale-Revised. New York: The Psychological Corporation, 1984.
Reitan RM. Validity of the Trail Making Test as an indicator of brain damage. Percept Mot Skills. 1958;8:271–6.
Storandt M, Botwinick J, Danziger WL, Berg L, Hughes CP. Psychometric differentiation of mild senile dementia of the Alzheimer type. Arch Neurol. 1984;41:497–9.
Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral gray matter of elderly subjects. Br J Psychiatry. 1968;114:797–811.
Weintraub S, Barataz R, Mesulam MM. Daily living activities in the assessment of dementia. In: Corkin S, Davis KL, Crowden JH, Usdin E, Wurtman JJ (eds). Alzheimer’s disease: a report of research in progress. New York: Raven Press, 1982;189–92.
Laux LF, Breisford JJ, Mayer D. Locus of control, age, and driving. Gerontologist. 1990;30:52A.
Teri L, Hughes JR, Larson EB. Cognitive deterioration in Alzheimer’s disease: behavior and health factors. J Gerontol. 1989;45:58–63.
Transportation Research Board. Transportation in an aging society (vols 1 and 2). Washington, DC: National Research Council, 1988.
Transportation Research Board. Report of the Basic Research Subcommittee Older Driver Task Force. Washington, DC: TRB Older Driver Task Force, 1991.
Hunt LA, Edwards D, Morris JC, Mui A. Driving performance in mild senile dementia of the Alzheimer’s type. Ann Neurol. 1990;28:228–9.
Rebok GW, Bylsma FW, Keyl PM. The effects of Alzheimer’s disease on elderly drivers. Gerontologist. 1990;30:194.
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Received from the University of Washington School of Medicine, Seattle, Washington.
Supported by NIMH MH17162 and NIA AG05136.
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Logsdon, R.G., Teri, L. & Larson, E.B. Driving and alzheimer’s disease. J Gen Intern Med 7, 583–588 (1992). https://doi.org/10.1007/BF02599195
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DOI: https://doi.org/10.1007/BF02599195