Cognitive impairment and driving: A review of the literature

Apolinario, Daniel; Magaldi, Regina Miksian; Busse, Alexandre Leopold; Lopes, Leonardo da Costa; Kasai, Juliana Yumi Tison; Satomi, Erika

doi:10.1590/S1980-57642009DN30400004

Abstract

Although some drivers with mild dementia may continue to drive after the condition has been diagnosed, the ability to drive a motor vehicle safely is eventually lost as the disease progresses. Clinicians involved in dementia care are often asked to make an assessment on whether a patient is fit to drive, even though they often lack basic knowledge and formal training in this area. The purpose of this review was to identify the factors that may differentiate safe from unsafe drivers with cognitive impairment and to discuss management strategies. Isolated information about staging measures or particular cognitive tests was found to be insufficient for decision making. Driving fitness counseling for patients with cognitive impairment requires a solid knowledge base, comprehensive assessment and thoughtful communication.

Key words:
automobile driving; cognition; dementia; aged.

Resumo

Alguns pacientes com demência leve continuam a dirigir após o diagnóstico, mas a habilidade de conduzir um veículo automotor com segurança é perdida à medida que a doença progride. Apesar de muitas vezes não reunirem conhecimento e treinamento formal para essa tarefa, os profissionais de saúde envolvidos na atenção ao paciente com demência precisam emitir recomendações relativas à capacidade desses indivíduos em conduzir um veículo. Essa revisão tem o objetivo de identificar fatores que possam determinar se um indivíduo com comprometimento cognitivo é capaz de conduzir um veículo com segurança. Informações isoladas relativas ao estadiamento ou a testes cognitivos específicos não parecem ser suficientes para uma tomada de decisão apropriada. O aconselhamento nessa situação exige conhecimentos sólidos aplicados a uma avaliação ampla, além de estratégias de comunicação apropriadas ao contexto.

Palavras-chave:
condução de veículo; cognição; demência; idoso.

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References

¹
Lafont S, Laumon B, Helmer C, Dartigues JF, Fabrigoule C. Driving cessation and self-reported car crashes in older drivers: the impact of cognitive impairment and dementia in a population-based study. Geriatr Psychiatry Neurol 2008;21: 171-182.
²
Hopkins RW, Kilik L, Day DJA, Rows C, Tseng H. Driving and dementia in Ontario: a quantitative assessment of the problem. Can J Psychiatry 2004;49:434-438.
³
Glasgow N. Older Americans' patterns of driving and using other transportation. Rural America 2000:15:26-31.
⁴
Adler G, Rottunda S, Dysken M. The older driver with dementia: an updated literature review. J Safety Res 2005;36:399-407.
⁵
Sachs GA. Dementia and the goals of care. J Am Geriatr Soc 1998;46:782-783.
⁶
Epp TD. Person-centred dementia care: a vision to be refined. The Canadian Alzheimer Disease Review. 2003;5:14-18.
⁷
Ott BR, Heindel WC, Papandonatos GD, et al. A longitudinal study of drivers with Alzheimer disease. Neurology. 2008; 70:1171-8.
⁸
Duchek JM, Carr DB, Hunt L, et al. Longitudinal driving performance in early-stage dementia of the Alzheimer type. J Am Geriatr Soc 2003;51:1342-1347.
⁹
Carr DB, Meuser TM, Morris JC. Driving retirement: the role of the physician. CMAJ 2006;175:601.
¹⁰
Stutts JC, Stewart JR, Martell C. Cognitive test performance and crash risk in an older driver population. Accid Anal Prev 1998;30:337-346.
¹¹
Foley DJ, Masaki KH, Ross GW, White LR. Driving cessation in older men with incident dementia. J Am Geriatr Soc 2000; 48:928-930.
¹²
Herrmann N, Rapoport MJ, Sambrook R, Hebert R, McCracken P, Robillard A. Predictors of driving cessation in mild-to-moderate dementia. CMAJ 2006;175:591-595.
¹³
Adler G, Kuskowski M. Driving cessation in older men with dementia. Alzheimer Dis Assoc Disord 2003;17:68-71.
¹⁴
Ackerman ML, Edwards JD, Ross LA, Ball KK, Lunsman M. Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years. Gerontologist 2008;48:802-810.
¹⁵
Talbot A, Bruce I, Cunningham CJ, et al. Driving cessation in patients attending a memory clinic. Age Ageing 2005;34:363-368.
¹⁶
Campbell MK, Bush TL, Hale WE. Medical conditions associated with driving cessation in community-dwelling, ambulatory elders. J Gerontol 1993;48:S230-S234.
¹⁷
Logsdon RG, Teri L, Larson EB. Driving and Alzheimer's disease. Gen Intern Med 1992;7:583-588.
¹⁸
Freund B, Szinovacz M. Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities. Gerontologist 2002; 42:621-633.
¹⁹
Man-Son-Hing M, Marshall SC, Molnar FJ, Wilson KG. Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. J Am Geriatr Soc 2007;55:878-84.
²⁰
Berndt A, Clark M, May E. Dementia severity and on-road assessment: briefly revisited. Australas J Ageing. 2008;27:157-160.
²¹
Dubinsky RM, Stein AC, Lyons K. Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology 2000;54:2205-2211.
²²
Wadley VG, Okonkwo O, Crowe M, et al. Mild cognitive impairment and everyday function: an investigation of driving performance. J Geriatr Psychiatry Neurol 2009;22:87-94.
²³
Frittelli C, Borghetti D, Iudice G, et al. Effects of Alzheimer's disease and mild cognitive impairment on driving ability: a controlled clinical study by simulated driving test. Int J Geriatr Psychiatry 2009;24:232-238.
²⁴
Badenes Guia D, Casas Hernanz L, Cejudo Bolivar JC, Aguilar Barberà M. Evaluation of the capacity to drive in patients diagnosed of mild cognitive impairment and dementia. Neurologia 2008;23:575-582.
²⁵
Reger MA, Welsh RK, Watson GS, Cholerton B, Baker LD, Craft S. The relationship between neuropsychological functioning and driving ability in dementia: a meta-analysis. Neuropsychology 2004;18:85-93.
²⁶
Dawson JD, Anderson SW, Uc EY, Dastrup E, Rizzo M. Predictors of driving safety in early Alzheimer disease. Neurology 2009;72:521-527.
²⁷
Grace J, Amick MM, D'Abreu A, Festa EK, Heindel WC, Ott BR. Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease. J Int Neuropsychol Soc 2005;11:766-775.
²⁸
Silva MT, Laks J, Engelhardt E. Neuropsychological tests and driving in dementia: a review of the recent literature. Rev Assoc Med Bras 2009;55:484-488.
²⁹
Friedland R, Koss E, Kumar A, et al. Motor vehicle crashes in dementia of the Alzheimer type. Ann Neurol 1988;24:782-786.
³⁰
Drachman DA, Swearer JM. Driving and Alzheimer's disease: The risk of crashes. Neurology 1993;43:2448-2456.
³¹
Zuin D, Ortiz H, Boromei D, Lopez OL. Motor vehicle crashes and abnormal driving behaviors in patients with dementia in Mendoza, Argentina. Eur J Neurol 2002;9:29-34.
³²
Trobe JD, Waller PF, Cook-Flannagan CA, Teshima SM, Bieliauskas LA. Crashes and violations among drivers with Alzheimer disease. Arch Neurol. 1996;53:411-416.
³³
Cooper PJ, Tallman K, Tuokko H, et al. Vehicle crash involvement and cognitive deficit in older drivers. J Safety Res 1993; 24:9-17.
³⁴
Carr DB, Duchek J, Morris JC. Characteristics of motor vehicle crashes in drivers with dementia of the Alzheimer type. J Am Geriatr Soc 2000;48:18-22.
³⁵
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A diagnostic formulation for anosognosia in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2006;77:719-725.
³⁶
Starkstein SE, Jorge R, Mizrahi R, Adrian J, Robinson RG. Insight and danger in Alzheimer's disease. Eur J Neurol 2007; 14:455-460.
³⁷
Hunt L, Morris JC, Edwards D, Wilson BS. Driving performance in persons with mild senile dementia of the Alzheimer type. J Am Geriatr Soc 1993;41:747-752.
³⁸
Shua-Haim JR, Gross JS. The "co-pilot" driver syndrome. J Am Geriatr Soc 1996;44:815-817.
³⁹
Fox GK, Bowden SC, Bashford GM, Smith DS. Alzheimer's disease and driving: prediction and assessment of driving performance. J Am Geriatr Soc 1997;45:949-953.
⁴⁰
Michon A, Deweer B, Pillon B, Agid Y, Dubois B. Relation of anosognosia to frontal lobe dysfunction in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1994;57:805-809.
⁴¹
Salmon E, Perani D, Herholz K, et al. Neural correlates of anosognosia for cognitive impairment in Alzheimer's disease. Hum Brain Mapp 2006;27:588-597.
⁴²
Barbas NR, Wilde EA. Competency issues in dementia: medical decision making, driving, and independent living. J Geriatr Psychiatry Neurol 2001;14:199-212.
⁴³
Snyder CH. Dementia and driving: autonomy versus safety. J Am Acad Nurse Pract 2005;17:393-402.
⁴⁴
Brown LB, Ott BR. Driving and dementia: a review of the literature. J Geriatr Psychiatry Neurol 2004;17:232-240.
⁴⁵
Meuser TM, Carr DB, Ulfarsson GF. Motor-vehicle crash history and licensing outcomes for older drivers reported as medically impaired in Missouri. Accid Anal Prev 2009;41: 246-252.
⁴⁶
Carr DB, Duchek JM, Meuser TM, Morris JC. Older adult drivers with cognitive impairment. Am Fam Physician 2006; 73:1029-1034.
⁴⁷
Molnar FJ, Patel A, Marshall SC, Man-Son-Hing M, Wilson KG. Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: A systematic review. J Am Geriatr Soc 2006;54:1809-1824.
⁴⁸
Wang CC. Physician's guide to assessing and counseling older drivers. Chicago: American Medical Association, 2003. Accessed online September 10, 2009, at: http://www.ama-assn.org/ama/pub/category/10791.html.
⁴⁹
Patterson CJ, Gauthier S, Bergman H et al. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. CMAJ 1999;160:S1-S15.
⁵⁰
Odenheimer GL, Beaudet M, Jette AM, et al. Performance-based driving evaluation of the elderly driver: safety, reliability, and validity. J Gerontol 1994;49:M153-159.
⁵¹
Taylor BD, Tripodes S. The effects of driving cessation on the elderly with dementia and their caregivers. Accid Anal Prev 2001;33:519-528.
⁵²
Perkinson MA, Berg-Weger ML, Carr DB, et al. Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders. Gerontologist. 2005;45:676-685.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
20 Oct 2009
Accepted
13 Nov 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Lafont S, Laumon B, Helmer C, Dartigues JF, Fabrigoule C. Driving cessation and self-reported car crashes in older drivers: the impact of cognitive impairment and dementia in a population-based study. Geriatr Psychiatry Neurol 2008;21: 171-182.

[2] ²
Hopkins RW, Kilik L, Day DJA, Rows C, Tseng H. Driving and dementia in Ontario: a quantitative assessment of the problem. Can J Psychiatry 2004;49:434-438.

[3] ³
Glasgow N. Older Americans' patterns of driving and using other transportation. Rural America 2000:15:26-31.

[4] ⁴
Adler G, Rottunda S, Dysken M. The older driver with dementia: an updated literature review. J Safety Res 2005;36:399-407.

[5] ⁵
Sachs GA. Dementia and the goals of care. J Am Geriatr Soc 1998;46:782-783.

[6] ⁶
Epp TD. Person-centred dementia care: a vision to be refined. The Canadian Alzheimer Disease Review. 2003;5:14-18.

[7] ⁷
Ott BR, Heindel WC, Papandonatos GD, et al. A longitudinal study of drivers with Alzheimer disease. Neurology. 2008; 70:1171-8.

[8] ⁸
Duchek JM, Carr DB, Hunt L, et al. Longitudinal driving performance in early-stage dementia of the Alzheimer type. J Am Geriatr Soc 2003;51:1342-1347.

[9] ⁹
Carr DB, Meuser TM, Morris JC. Driving retirement: the role of the physician. CMAJ 2006;175:601.

[10] ¹⁰
Stutts JC, Stewart JR, Martell C. Cognitive test performance and crash risk in an older driver population. Accid Anal Prev 1998;30:337-346.

[11] ¹¹
Foley DJ, Masaki KH, Ross GW, White LR. Driving cessation in older men with incident dementia. J Am Geriatr Soc 2000; 48:928-930.

[12] ¹²
Herrmann N, Rapoport MJ, Sambrook R, Hebert R, McCracken P, Robillard A. Predictors of driving cessation in mild-to-moderate dementia. CMAJ 2006;175:591-595.

[13] ¹³
Adler G, Kuskowski M. Driving cessation in older men with dementia. Alzheimer Dis Assoc Disord 2003;17:68-71.

[14] ¹⁴
Ackerman ML, Edwards JD, Ross LA, Ball KK, Lunsman M. Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years. Gerontologist 2008;48:802-810.

[15] ¹⁵
Talbot A, Bruce I, Cunningham CJ, et al. Driving cessation in patients attending a memory clinic. Age Ageing 2005;34:363-368.

[16] ¹⁶
Campbell MK, Bush TL, Hale WE. Medical conditions associated with driving cessation in community-dwelling, ambulatory elders. J Gerontol 1993;48:S230-S234.

[17] ¹⁷
Logsdon RG, Teri L, Larson EB. Driving and Alzheimer's disease. Gen Intern Med 1992;7:583-588.

[18] ¹⁸
Freund B, Szinovacz M. Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities. Gerontologist 2002; 42:621-633.

[19] ¹⁹
Man-Son-Hing M, Marshall SC, Molnar FJ, Wilson KG. Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. J Am Geriatr Soc 2007;55:878-84.

[20] ²⁰
Berndt A, Clark M, May E. Dementia severity and on-road assessment: briefly revisited. Australas J Ageing. 2008;27:157-160.

[21] ²¹
Dubinsky RM, Stein AC, Lyons K. Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology 2000;54:2205-2211.

[22] ²²
Wadley VG, Okonkwo O, Crowe M, et al. Mild cognitive impairment and everyday function: an investigation of driving performance. J Geriatr Psychiatry Neurol 2009;22:87-94.

[23] ²³
Frittelli C, Borghetti D, Iudice G, et al. Effects of Alzheimer's disease and mild cognitive impairment on driving ability: a controlled clinical study by simulated driving test. Int J Geriatr Psychiatry 2009;24:232-238.

[24] ²⁴
Badenes Guia D, Casas Hernanz L, Cejudo Bolivar JC, Aguilar Barberà M. Evaluation of the capacity to drive in patients diagnosed of mild cognitive impairment and dementia. Neurologia 2008;23:575-582.

[25] ²⁵
Reger MA, Welsh RK, Watson GS, Cholerton B, Baker LD, Craft S. The relationship between neuropsychological functioning and driving ability in dementia: a meta-analysis. Neuropsychology 2004;18:85-93.

[26] ²⁶
Dawson JD, Anderson SW, Uc EY, Dastrup E, Rizzo M. Predictors of driving safety in early Alzheimer disease. Neurology 2009;72:521-527.

[27] ²⁷
Grace J, Amick MM, D'Abreu A, Festa EK, Heindel WC, Ott BR. Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease. J Int Neuropsychol Soc 2005;11:766-775.

[28] ²⁸
Silva MT, Laks J, Engelhardt E. Neuropsychological tests and driving in dementia: a review of the recent literature. Rev Assoc Med Bras 2009;55:484-488.

[29] ²⁹
Friedland R, Koss E, Kumar A, et al. Motor vehicle crashes in dementia of the Alzheimer type. Ann Neurol 1988;24:782-786.

[30] ³⁰
Drachman DA, Swearer JM. Driving and Alzheimer's disease: The risk of crashes. Neurology 1993;43:2448-2456.

[31] ³¹
Zuin D, Ortiz H, Boromei D, Lopez OL. Motor vehicle crashes and abnormal driving behaviors in patients with dementia in Mendoza, Argentina. Eur J Neurol 2002;9:29-34.

[32] ³²
Trobe JD, Waller PF, Cook-Flannagan CA, Teshima SM, Bieliauskas LA. Crashes and violations among drivers with Alzheimer disease. Arch Neurol. 1996;53:411-416.

[33] ³³
Cooper PJ, Tallman K, Tuokko H, et al. Vehicle crash involvement and cognitive deficit in older drivers. J Safety Res 1993; 24:9-17.

[34] ³⁴
Carr DB, Duchek J, Morris JC. Characteristics of motor vehicle crashes in drivers with dementia of the Alzheimer type. J Am Geriatr Soc 2000;48:18-22.

[35] ³⁵
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A diagnostic formulation for anosognosia in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2006;77:719-725.

[36] ³⁶
Starkstein SE, Jorge R, Mizrahi R, Adrian J, Robinson RG. Insight and danger in Alzheimer's disease. Eur J Neurol 2007; 14:455-460.

[37] ³⁷
Hunt L, Morris JC, Edwards D, Wilson BS. Driving performance in persons with mild senile dementia of the Alzheimer type. J Am Geriatr Soc 1993;41:747-752.

[38] ³⁸
Shua-Haim JR, Gross JS. The "co-pilot" driver syndrome. J Am Geriatr Soc 1996;44:815-817.

[39] ³⁹
Fox GK, Bowden SC, Bashford GM, Smith DS. Alzheimer's disease and driving: prediction and assessment of driving performance. J Am Geriatr Soc 1997;45:949-953.

[40] ⁴⁰
Michon A, Deweer B, Pillon B, Agid Y, Dubois B. Relation of anosognosia to frontal lobe dysfunction in Alzheimer's disease. J Neurol Neurosurg Psychiatry 1994;57:805-809.

[41] ⁴¹
Salmon E, Perani D, Herholz K, et al. Neural correlates of anosognosia for cognitive impairment in Alzheimer's disease. Hum Brain Mapp 2006;27:588-597.

[42] ⁴²
Barbas NR, Wilde EA. Competency issues in dementia: medical decision making, driving, and independent living. J Geriatr Psychiatry Neurol 2001;14:199-212.

[43] ⁴³
Snyder CH. Dementia and driving: autonomy versus safety. J Am Acad Nurse Pract 2005;17:393-402.

[44] ⁴⁴
Brown LB, Ott BR. Driving and dementia: a review of the literature. J Geriatr Psychiatry Neurol 2004;17:232-240.

[45] ⁴⁵
Meuser TM, Carr DB, Ulfarsson GF. Motor-vehicle crash history and licensing outcomes for older drivers reported as medically impaired in Missouri. Accid Anal Prev 2009;41: 246-252.

[46] ⁴⁶
Carr DB, Duchek JM, Meuser TM, Morris JC. Older adult drivers with cognitive impairment. Am Fam Physician 2006; 73:1029-1034.

[47] ⁴⁷
Molnar FJ, Patel A, Marshall SC, Man-Son-Hing M, Wilson KG. Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: A systematic review. J Am Geriatr Soc 2006;54:1809-1824.

[48] ⁴⁸
Wang CC. Physician's guide to assessing and counseling older drivers. Chicago: American Medical Association, 2003. Accessed online September 10, 2009, at: http://www.ama-assn.org/ama/pub/category/10791.html.

[49] ⁴⁹
Patterson CJ, Gauthier S, Bergman H et al. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. CMAJ 1999;160:S1-S15.

[50] ⁵⁰
Odenheimer GL, Beaudet M, Jette AM, et al. Performance-based driving evaluation of the elderly driver: safety, reliability, and validity. J Gerontol 1994;49:M153-159.

[51] ⁵¹
Taylor BD, Tripodes S. The effects of driving cessation on the elderly with dementia and their caregivers. Accid Anal Prev 2001;33:519-528.

[52] ⁵²
Perkinson MA, Berg-Weger ML, Carr DB, et al. Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders. Gerontologist. 2005;45:676-685.

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