A longitudinal study of drivers with Alzheimer disease
StevenMandel MD, Jefferson Medical College, 900 Walnut Street, Philadelphia, PA 19107drmandel1979@aol.com
Edward A. Maitz, PhD
Submitted September 22, 2008
The article by Ott et al. highlights the current concerns associated with driving privileges for older adults and patients with Alzheimer disease (AD). [1]
The lack of clear national standards and the lack of cognitive tests that have been validated for driving skills present a professional dilemma for neurologists and other physicians who evaluate and treat patients with various neurological disorders. The decisions that physicians make can potentially impact a patient's ability to safely operate a motor vehicle.
In the absence of clear regulatory statutes, many professional organizations and advocacy groups have developed position statements and recommendations regarding driving privileges for patients with neurological disorders. However, many physicians may not be aware that some states have laws that supersede the position statements of our professional organizations. Our review found six states that had mandatory reporting requirements. [2] While some states allow for confidential reporting, only a few states provide physicians immunity from legal action for filing a report.
It is also important to recognize that patients with other forms of dementia (reversible and nonreversible) also pose a driving risk. This will become problematic as the life expectancy of the general population continues to increase. Moreover, older people often seek part-time jobs that involve transporting other people. There should be stricter guidelines for those who operate school buses, limousines, taxicabs, and similar service vehicles. Because driving is part of an occupational responsibility, patients are often unable to avoid situations that could add additional risks such as driving in inclement weather, driving at night, or transporting other individuals with disabilities.
Like Ott et al., we recommend further research to empirically identify cognitive abilities that might put a patient at risk for driving. In addition, physicians should be provided with a validated screening battery to determine which patients might need more extensive neuropsychological testing or formal driving evaluation.
We also recommend establishing federal guidelines to protect society from those who may be incapable of safely operating a motor vehicle. In addition, separate guidelines should be developed for those who are responsible for transporting others. Like Ott et al., we support periodic re-evaluations, particularly for patients with progressive neurological disorders. Finally, laws should be enacted to protect mandatory reporters.
References
1. Ott BR, Heindel WC, Papandonatos GD et al. A longitudinal study of drivers with Alzheimer disease. Neurology 2008;70:1171-1178.
2. Tuckman H, Gordon G, Mandel S, Maitz E. Dementia and Driving: When Should You Put on the Brakes. Practical Neurology. June 2006, 18-22.
The article by Ott et al. highlights the current concerns associated with driving privileges for older adults and patients with Alzheimer disease (AD). [1]
The lack of clear national standards and the lack of cognitive tests that have been validated for driving skills present a professional dilemma for neurologists and other physicians who evaluate and treat patients with various neurological disorders. The decisions that physicians make can potentially impact a patient's ability to safely operate a motor vehicle.
In the absence of clear regulatory statutes, many professional organizations and advocacy groups have developed position statements and recommendations regarding driving privileges for patients with neurological disorders. However, many physicians may not be aware that some states have laws that supersede the position statements of our professional organizations. Our review found six states that had mandatory reporting requirements. [2] While some states allow for confidential reporting, only a few states provide physicians immunity from legal action for filing a report.
It is also important to recognize that patients with other forms of dementia (reversible and nonreversible) also pose a driving risk. This will become problematic as the life expectancy of the general population continues to increase. Moreover, older people often seek part-time jobs that involve transporting other people. There should be stricter guidelines for those who operate school buses, limousines, taxicabs, and similar service vehicles. Because driving is part of an occupational responsibility, patients are often unable to avoid situations that could add additional risks such as driving in inclement weather, driving at night, or transporting other individuals with disabilities.
Like Ott et al., we recommend further research to empirically identify cognitive abilities that might put a patient at risk for driving. In addition, physicians should be provided with a validated screening battery to determine which patients might need more extensive neuropsychological testing or formal driving evaluation.
We also recommend establishing federal guidelines to protect society from those who may be incapable of safely operating a motor vehicle. In addition, separate guidelines should be developed for those who are responsible for transporting others. Like Ott et al., we support periodic re-evaluations, particularly for patients with progressive neurological disorders. Finally, laws should be enacted to protect mandatory reporters.
References
1. Ott BR, Heindel WC, Papandonatos GD et al. A longitudinal study of drivers with Alzheimer disease. Neurology 2008;70:1171-1178.
2. Tuckman H, Gordon G, Mandel S, Maitz E. Dementia and Driving: When Should You Put on the Brakes. Practical Neurology. June 2006, 18-22.
Disclosures: The authors report no disclosures.