Driving Assessment Test For Dementia

How Does Dementia Affect Driving Ability

Dementia can make driving unsafe because it can affect someones ability to coordinate multiple tasks, judge distances and speed, stay alert, process information, remember directions and cope with stressful situations.

Being diagnosed with dementia does not mean the person has to stop driving straight away. But as the disease progresses, they will eventually need to stop driving.

Risky Driving Behaviours Caused By Dementia

If you’ve been driving for many years, driving may feel mostly automatic. However, as dementia progresses, it will change your abilities, such as your level of concentration, judgement, orientation, perception and physical ability â all important and necessary skills for driving.

As a result, regardless of your driving skill and experience before you started having symptoms, your dementia will eventually put you at a higher risk for the following driving behaviours:

• Slow response times,
• Taking too much time to reach a destination or not reaching the destination at all,
• Driving too slowly or too fast,
• Driving through stop signs or red traffic lights,
• Stopping at green traffic lights,
• Having difficulty merging with traffic,
• Making left hand turns in the face of oncoming traffic and pedestrians crossing the intersection.

These behaviours can increase your risk of a collision, which can cause serious injury and death for you and other people.

About Cognitive Impairment And Dementia

Cognitive impairment, also called cognitive dysfunction or neuropsychological impairment, refers to any impairment of a cognitive function such as:

Cognitive impairment may have any number of causes including:

• Brain trauma
• Toxicities, or
• Degenerative, metabolic or nutritional diseases

The presentation of cognitive impairment is variable depending on the cognitive functions affected and the degree of impairment. Cognitive impairment may progress to dementia, it may remain stable, or there may be a recovery of normal cognitive function.

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Signs That Dementia May Be Affecting A Persons Driving

Changes in driving behaviour may have been occurring for some time without being noticed. Consider the following driving warning signs:

• Vision Can they see things coming straight at them and from the sides? Can they see and respond appropriately to traffic signs and signals?
• Hearing Can they hear the sound of approaching cars, car horns and sirens and respond appropriately? Do they pay attention to these when in the car?
• Reaction time Can they turn, stop or speed up their car quickly?
• Problem solving Do they become upset and confused when more than one thing happens at the same time?
• Coordination Is their coordination affected? Do they get the brake and accelerator pedals mixed up?
• Alertness Are they aware and understand what is happening around them?
• Can they tell the difference between left and right?
• Do they become confused on familiar routes? Do they get lost or take a long time on familiar journeys?
• Do they understand the difference between Stop and Go coloured lights?
• Are they able to stay in the correct lane?
• Can they read a road map and follow detour routes?
• Has their mood changed when driving? Some previously calm drivers may become angry or aggressive.
• Are there new bumps and scratches on the car?

Information For Healthcare Providers On Dementia And Driving

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

The following information is taken from dementia and driving safety a clinical guideline Auckland, Counties Manukau, Waitemat and Northland DHBs, NZ, 2014.

Read more dementia and driving safety a clinical guideline Auckland, Counties Manukau, Waitemata and Northland DHBs, NZ, 2014

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Cognitive Impairment Or Dementia

Having The Conversation About Stopping Driving

Whenever it happens, the decision to stop driving won’t be easy âand neither will the conversation that leads to that decision:

• After all, you’re losing the privilege to drive due to changes in your abilities that you can’t stop âbecause of this, it’s totally normal to feel angry, sad, frustrated or hopeless.
• As well, it may add a strain on the relationship between you and your friends and family . They will likely notice changes in your abilities before you do, and may be the first to discuss whether you should stop driving.
• On the other hand, they may be hesitant to bring up the conversation about your driving ability, whether it’s out of a desire to see you live independently or to avoid conflict in your relationship with each other.

Although losing the privilege of driving can be difficult, it’s important to remember that it can be equally, if not more devastating, to be involved in a motor vehicle collision. A collision can result in serious disability or death for you or in trauma and death of others.

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Arrange For An Independent Driving Evaluation

The safest option for assessing a personâs driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles .

Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides.

Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.

Skills Needed To Drive Safely

These are the skills a person must have to drive safely:

• good vision in front and out of the corners of the eyes
• quick reactions to be able to brake or turn to avoid crashes
• good coordination between eyes, hands and legs
• the ability to make decisions quickly
• the ability to make judgements about whats happening on the road.

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Involve Person In Discussions

Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. Encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive. Support groups provide a good venue for both the caregivers and the individual to talk about their feelings and get advice from others in a similar situation. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.

If the individual is reluctant to talk about driving, ask the individualâs physician or care manager to bring up the subject of driving during health care visits. A lawyer or financial planner may also be willing to discuss driving as part of the individualâs legal and financial planning.

Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will need to find the solutions that work best in their situation.

Reduce The Need To Drive

Individuals able to maintain an active life often adjust better to the loss of driving privileges. Following are some ways to reduce the need to drive:

• Have groceries, meals, and prescriptions delivered to the home.
• Arrange for a barber or hairdresser to make home visits.
• Invite friends and family over for regular visits.
• Arrange for family and friends to take the individual on social outings.

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How The Tmt Is Used Today

The Trail Making Test is commonly used as a tool to identify and diagnose many types of brain impairment, particularly those involving the frontal lobes. This is the part of the brain that controls high-level cognitive skills like planning, self-control, memory formation, empathy, and attention.

Talk To Your Gp About Whether You Can Still Drive

If you have been diagnosed with dementia, you must talk to your GP about whether its safe to keep driving or not. While driving provides independence, it can be unsafe if your brain isnt functioning as it should be.

Your doctor has a legal duty to make an assessment of your ability to continue driving. They may refer you to an occupational therapist for a driving assessment. This assessment is different from a routine driving test. Doctors are legally obliged to let Waka Kotahi know if they think a person is unfit to drive but likely to carry on driving.

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Continue To Monitor Driving

If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individualâs driving behavior, as the individualâs driving skills may decrease significantly in a short period of time. The objective of monitoring is to detect a problem before it becomes a crisis. If there are any doubts about safety, the person with dementia should not be driving.

It is often helpful to keep a written log of each incident of poor driving behavior. Following are some of the common warning signs.

• Drives too slowly.
• Gets ticketed for traffic violations.
• Is increasingly nervous or irritated when driving.
• Has accidents, near misses, or âfender benders.â

Discuss any concerns you have with the individual, family members, and health care providers. All involved will need to weigh potential risks and decide when the individual needs to stop.

Legal Requirements: Driving Tests And Medical Clearance

To keep driving, the person with dementia will need a medical assessment from their doctor using the Assessing Fitness to Drive National Standards.

If you have dementia, you are required by law to notify your states road traffic authority. If you continue to drive and are a serious risk on the roads, your doctor is legally authorised and obliged to notify authorities.

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Driving Is Something Most People Take For Granted

It gives us freedom, flexibility and independence. While we will all need to step out from behind the wheel one day, conditions such as dementia can mean that the decision to stop driving needs to be planned for and made much earlier than expected.

Driving can seem like an automatic activity. However, it is a complicated task that requires complex thought processes, manual skills and fast reaction times. Dementia can cause loss of memory, limited concentration, and vision and insight problems. This affects a persons judgement and ability to drive safely.

A diagnosis of dementia does not always mean that a person has to give up driving straight away. Because the condition involves a gradual decline in cognitive and physical ability however, they will need to stop driving at some point.

The experience of giving up driving can be very difficult for many people, and the sense of grief and loss can be ongoing.

For quality of life and wellbeing, its vital to think about and plan ways that a person living with dementia and their families and carers can keep mobile, active and socially connected in the transition to non-driving.

• Information for health professionals

A Helpful Test You Can Do

If you suspect a person may be showing signs of dementia, give them this simple test on common traffic signs.

Ask What does the sign mean? and What action should the driver take?

Suggested answers:

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Driving Assessment For Patients With Dementia: A How

Evaluating driving safety in patients with mild cognitive impairment or dementia can be challenging.

This MedCase discusses driving assessment for a patient with mild dementia using the 2014 Clinical guideline on Dementia and Driving Safety1 and the Hui Process,2 a four-step approach to building relationships with Mori patients and whnau.

When to assess?

How to assess fitness to drive in patients with dementia

Initial assessment

The first assessment should use readily available information to assess driving safety. Some things to consider:

Second assessment

If patients are unwilling or unable to undergo an OT assessment, then clinicians must rely on other sources of information, such as:

• Whakawhanaungatanga

Effect On Functional Ability To Drive

Cognitive impairments of any nature may, or may not, affect driver fitness since there is no uniform range of effects. There is no standard set of limitations, and they can vary greatly from one person to the other.

In the case of MCI the effects may be subtle and difficult to assess in an office setting.

Judgement and insight are important for driving yet the usual battery of tests used to assess the extent of cognitive limitations do not evaluate these functions. Hence, a functional driving assessment is usually the most appropriate means of assessing the effects of the cognitive limitations upon driving unless severe dementia has been demonstrated.

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Maintaining Your Driving Ability

The good news is that, while your symptoms are mild, you can take steps to help you drive safely and independently for as long as possible:

• Settle into a consistent routine. Stick to the same route when you drive from place to place. Figure out when you most need to drive, and follow that plan. For example, do you drive to medical appointments, to shop, to meet with friends? Are there times when someone else can drive?
• Drive with someone that can assess your driving abilities on an ongoing basis. They can notice if there are any changes in your driving abilities and can spot risky behaviours that you may not be aware of.
• Use technology to support your capacity to drive. If you’re driving by yourself, use assistive technologies such as a GPS to help you.
• Above all, living well with dementia has been shown to slow the progression of dementia. Challenging your brain, following a good diet and staying physically and socially active will all help you stay in the early stage of dementia for as long as possible.

Transitioning To Living Without Driving

To help you plan ahead for the time when you must stop driving, consider the following strategies:

• Consider alternative forms of transportation. These can be public transit, taxis, services provided by community organizations, and transportation organized by family members and friends.
• Use these alternative forms of transportation while it is still safe for you to drive. This will help you get used to new routines that you will transition to after you hang up the car keys for good. As well, this may help you accept the difficult decision to stop driving when it eventually comes.
• Look into companies that offer home delivery services. These can be pharmacy or grocery home delivery services.

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Suggested Questions To Ask The Patient And Family

Red flags

• Accidents, new bumps/scratches, near misses
• Disorientated/lost on familiar routes
• Difficulty reading maps and following detours
• Difficulty making quick decisions at intersections or busy roads
• Not seeing vehicles, pedestrians or cyclists sharing the roadway
• Difficulty controlling the car

• Patient or others concerned with his/her driving
• Forgetting purpose of trip
• Self-regulating driving e.g. avoiding night driving, busy roads or long distances

When Persuasion Fails

Ideally, an individual will limit or stop driving on his or her own. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. While it is important to maintain respect for the individualâs feelings, you must put safety first.

As a last resort, you may have to prevent his or her access to a car. Some methods to do that include:

• Hiding the car keys.
• Replacing the car keys with a set that wonât start the car.
• Disabling or selling the car.
• Moving the car out of sight.

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