Guidelines issued on risk of driving with Alzheimer's

provided by American Academy of Neurology

he American Academy of Neurology has issued guidelines to help determine whether people with Alzheimer's disease should continue driving. The guidelines are published in the June 27 issue of Neurology, the scientific journal of the American Academy of Neurology.

"Driving is often necessary for people to remain independent in our society, but accidents are a major cause of injury and death," said neurologist Richard Dubinsky, MD, coauthor of the guidelines. "The American Academy of Neurology developed these guidelines to help answer the question: Does driving by people with Alzheimer's pose a significant traffic safety problem?"

To develop the guidelines, researchers searched medical databases and literature for scientific studies published in this area. They found 14 relevant studies in three categories: studies that looked at the rate of accidents in drivers with Alzheimer's; studies that involved on-the-road or simulated performance tests; and studies that evaluated how well people with Alzheimer's can process what they see when driving.

The researchers looked at the risks of driving for people with Alzheimer's and compared them to the risks found in other groups of drivers, such as 16- to 21-year-olds or people driving under the influence of alcohol but within the legal limit.

"Drivers with Alzheimer's disease have a substantially increased rate of accidents and driving performance errors," said Dubinsky, who is an associate professor of neurology at Kansas University Medical Center in Kansas City. "They pose a significant traffic safety risk, and should be advised not to drive. Any recommendations by health care providers about driving by people with Alzheimer's disease must comply with state laws and be made in conjunction with evaluation of the individual patient and with the input of their care-giver."

The guidelines state that driving performance evaluations should be considered for people with slight cognitive impairment, or a Clinical Dementia Rating of 0.5.

This state is characterized by consistent slight forgetfulness that is "benign," or does not interfere with everyday activities. It also involves slight impairment in activities at home and with hobbies. Patients with slight cognitive impairment are fully capable of handling their personal care needs such as dressing and hygiene.

These patients have an increased risk of accidents when compared to other elder drivers, but their risk is similar to that of 16- to 21-year-olds or to drivers with a blood alcohol level of less than .08, which is the lowest limit imposed in the United States.

The guidelines also recommend that these patients be reassessed every six months because of the likelihood that their level of dementia will increase to CDR 1 within a few years.

The guidelines also recommend areas where more research is needed.

"More research should be done to determine whether there are groups of patients with dementia (CDR 1) who can drive safely, or can drive safely with certain restrictions, such as non-highway driving or driving within a limited geographic area," said Dubinsky.

The guidelines also call for research into the type and severity of accidents. "It may be possible that if there are typical accidents that involve drivers with Alzheimer's disease, driving limitations or technological solutions could be used to decrease the risk of accidents," Dubinsky said.

The American Academy of Neurology, an association of more than 16,500 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. For more information about the American Academy of Neurology, visit its Web site at For online neurological health and wellness information, visit NeuroVista at