Assessment and management of the dementing driver

Abstract

Driving skills inevitably become compromised at some stage early in the course of progressive dementia. A survey of patients referred to a Memory Clinic found that 20% were current drivers and it was, therefore, important carefully to address the issue of driving safety with this group. Following initial assessment, over half were advised to stop and many did so without major objections, or with family persuasion to enforce the advice. Most carers had good insight into this issue and were often relieved when the patient was given very direct advice to stop driving. A minority were discontented, suggesting that carers cannot always be relied upon to have good judgement about driving safety. Detailed neuropsychological assessment can provide valuable information to help guide decisions, especially in the early stages of dementia when individuals may still score well on brief cognitive screening tools such as the Mini Mental State Examination. However, poor insight and loss of reasoning ability may often hamper compliance. Good interdisciplinary management should therefore ensure that patients and carers are provided with timely and informed advice and explanation about driving safety and the necessary practical support to adjust to driving cessation.