12:16am Thursday 23 November 2017

Guidelines suggested on Alzheimer's disease and driving

The new guidelines issued by the American Academy of Neurology were published in the April 12 online issue of the journal Neurology and were written by a team of specialist clinicians including a neurologist with University of Iowa Health Care. The lead guideline author was Donald J. Iverson, M.D., with the Humboldt Neurological Medical Group, Inc. in Eureka, Calif.

The team, which included senior author Matthew Rizzo, M.D., UI professor of neurology, engineering and public policy, evaluated which tests and observations were most useful for predicting increased risk of unsafe driving among patients with dementia.

“Although severe dementia significantly impairs driving skills, for patients with mild dementia, the situation is less clear cut,” Rizzo said. “In fact, as many as three in four patients with mild dementia may be considered safe drivers based on their ability to pass an on-road driving test.

“With these uncertainties, as well as a concern that we not restrict driving for people who can still safely do so, we developed these guidelines to help clinicians identify which patients may be at higher risk of unsafe driving,” Rizzo added.

The guidelines establish that a test known as the Clinical Dementia Rating scale is useful in identifying potentially unsafe drivers and recommends that clinicians use it. This tool allows clinicians to integrate information from caregivers and direct examination of patients to determine the severity of a patient’s dementia. Conversely, the guidelines find that a patient’s self-rating of safe driving ability is not a reliable indicator of safe driving ability.

The guidelines also found that caregivers’ concerns that a patient’s driving had become “marginal” or “unsafe” were often accurate and should be part of the clinician’s overall assessment of a patient’s driving capability.

Warning signs of unsafe driving due to dementia that caregivers and family members might observed include:
–Decreased miles being driven.
–Collisions.
–Moving violations.
–Avoiding certain driving situations, such as driving at night or in the rain.
–Aggressive or impulsive personality traits.

Rizzo noted that the new guidelines did not fully address a number of cognitive tests that currently are used to help assess driver safety. These include tests of memory, attention, decision-making and spatial ability. These issues will likely be addressed in future guidelines.

“Assessing a patient’s driving skills is a complex process, and clinicians need to use multiple sources of information as they work with patients with dementia and their families to determine when to recommend that a patient stop driving,” Rizzo said.

In addition, the laws regarding whether a physician must report medical conditions that may affect driving ability vary from state to state. Iowa does not have a mandatory reporting requirement for physicians. However, if a doctor has discussed with a patient and their family a recommendation not to drive, but feels that the patient may continue to drive and will pose a risk to self and others, then the physician may report that patient to the state.

STORY SOURCE: University of Iowa Health Care Media Relations, 200 Hawkins Drive, Room W319 General Hospital, Iowa City, Iowa 52242-1009

MEDIA CONTACT: Jennifer Brown, 319-356-7124, jennifer-l-brown@uiowa.edu

NOTE TO EDITORS: This release includes information from a news release issued by the American Academy of Neurology.


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