Driving and Alzheimer's Disease - When It's Time To Hand Over Keys

The caregivers of my patients frequently ask me about the safety of their loved ones getting behind the wheel after receiving a diagnosis of Alzheimer's Disease (AD). This is a sensitive topic for patients, but a very important one in terms of both safety and liability, as I will discuss here.

First, my own research has recently revealed that driving in moderate and late stage AD is a much larger problem than we first feared, and this is not attributable merely to aging. In fact, we have seen that 16 year old males have a higher incidence of accidents than healthy non-demented individuals over the age of 75. However, in mild cognitive impairment (MCI) and the early stages of AD, we do not see increased accident rates. But as early AD progresses into moderate AD accident rates rise sharply.

I've done some research correlating test scores to driving safety and will discuss that more in a later article. For now let me just say that by the time a patient's MMSE (mini mental status exam) or ALZselftest score is as low as 20, they are at a increased risk of having an accident while driving. Put simply, these people should not be driving.

A complicating factor here is that a portion of AD patients who also have Anosognosia, may believe they are perfectly healthy and see no reason not to drive. I had a very distraught family come in one day and tell me that in spite of all their efforts, they could not get the patient to stop driving. He ended up getting into the back seat of the car, becoming very angry and accusing his family of stealing the steering wheel, yet he was certain he was okay to drive. These are the patients that refuse to give up the keys, exacerbating the problem.

Complicating things for the family is the fact that, according to the legal system, the family could possibly be held liable if their loved one takes the car and gets into an accident. The family could well be sued and held financially responsible.

As a physician, here are the things that I do with my patients, and suggest to others, to help support both the family and the patient, and especially to keep everyone involved safe and protected.

• The healthcare provider should assume responsibility - I always explain to my patients that I am a professional with a lot of experience in this area and, based on their test results I believe that they should not be driving. I attempt to be very fact-based in this delivery, explaining the results of their test scores (MMSE, ALZselftest, etc.) and indicate that they fall into a group with high accident rates.
• Next, I physically write a prescription and hand it to them, instructing them "no driving." This prescription goes home with them and is placed on the refrigerator, or bathroom mirror, or somewhere they will see it regularly.
• Sometimes I offer my patients a follow up call. This is a buffer to allow them time to get used to the idea, and to give some space to the subject of driving as an option. In the office I tell them if they get home and still feel they need to discuss it, to give me a call back. I've made this offer over 500 times and no one has taken me up on it.
• I enable the family to agree with the patient, rather than argue. Family members can say "Hey, we agree with you about driving but, unfortunately the doctor said no, as you can see from this prescription. We cannot go against the doctor."
• If necessary, I encourage the family to disable the car - often after a couple of weeks the patient will simply stop inquiring about driving.

The best way to both support the patient and ease the stress on the family is for the healthcare provider to assume full responsibility for the decision to take away driving. If you are a caregiver with these concerns, talk to your healthcare provider privately and ask for support in making this decision.

Whatever you do, do not ignore the problem. This is a problem than can and does cost lives. If you doubt your loved ones ability to drive, do not allow it until you can receive further assessment from your physician, and receive professional support for taking driving away. And above all, be sensitive in delivery of this news. Driving is a freedom that is very upsetting to part with and should not be taken lightly. But it should be taken when the patient becomes too impaired. Using these tips, the process should go much more smoothly for everyone involved.

I wish you good health.