Driving with Alzheimer's - Many Difficult Decisions
Posted on Wed, Mar 17, 2010 @ 10:10 AM
Driving with Alzheimer's Can Mean Death is the title of a recent article highlighting a clinical study that is attempting to answer many of the difficult questions about driving that come with a diagnosis of Alzheimer's disease.
As a neurologist caring for patients with Alzheimer's and other cognitive disorders I face the "driving question" daily. Most places in America do not, and never will, have adequate public transportation, and we do not yet have cars which drive themselves (how many problems that would solve!). Taking away driving privileges, therefore, is not to be done lightly. At the same time we've all seen stories like the elderly priest who ran over a pedestrian, drove home with the dying man still draped over the car's hood, parked in the garage, and went in to make supper...leaving the pedestrian to die in the garage. Or how about the Kansas lady who fatally ran over a child getting off the school bus, and later denied ever seeing a bus? How can we decide when to write that letter to the DMV revoking the patient's driver's license (after I send my letter in, the patient will usually receive notice from the state within a week or two that their license has been permanently revoked)?
State driver's tests are almost never adequate to catch bad driving due to dementia. Medicare used to pay for private "driver re-evaluations," which always showed us exactly what to do, but they're not covered any more. Now the patient must foot the whole bill (usually $300), and places providing that service are growing scarce. I always poll family members, but denial, ulterior motives,
and lack of first-hand observers often make this an unreliable source. Fortunately, there is a strong correlation between a Mini Mental Status exam (MMSE) score below 25 (out of 30) and loss of driving skills. At our Memory Loss Center we revoke the license of any still-driving Alzheimer's patient scoring below 25, or sooner if we are given reason. Neither the state, nor the neurologist, however, can come out to the house and prevent the patient from driving. Only the family can enforce.
Until studies like this in Florida or elsewhere provide a better solution, I strongly recommend knowing what your loved-one's MMSE score is (there will be a little variability from clinic to clinic).
-by Dana Winegarner, DO