|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 65-66
Dementia and driving fitness: Critical clinical issues
Avinash De Sousa
Desousa Foundation, Mumbai, Maharashtra, India
|Date of Submission||22-Mar-2020|
|Date of Decision||16-May-2020|
|Date of Acceptance||18-Jun-2020|
|Date of Web Publication||29-Jun-2020|
Dr. Avinash De Sousa
Carmel, 18, St. Francis Road, Off S.V. Road, Santacruz West, Mumbai - 400 054, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
De Sousa A. Dementia and driving fitness: Critical clinical issues. J Geriatr Ment Health 2020;7:65-6
Many a times, the relatives of patients come to see us in the outpatient setting with a complaint that patients with dementia are driving and that we should not allow them to do so and rather certify that they cannot drive at all. The patients though having limited insight into their condition get upset and insist on wanting to drive and that they can drive well. The issue of certifying for driving fitness in dementia has some clinical issues that this letter wishes to state:
- Various studies have shown that a driver with dementia is at increased risk to cause traffic accidents and that the prevalence rate of crashes among persons with dementia compared to age-matched controls without dementia has always been far higher. There is a 5–10-fold increased risk of crashes for elderly drivers with mild-to-moderate dementia compared to age-matched normal populations. Given this evidence, it is particularly important to determine the most important cognitive or functional factors that contribute to driving impairment among those with dementia 
- There is assessment literature that suggests that performance on visuospatial abilities tests, attention, dexterity, concentration and executive functioning, may be important factors to consider regarding fitness to drive in dementia. These findings appear to make sense intuitively, although driving obviously requires many complex visuomotor and cognitive abilities. It is prudent that sound neuropsychological assessment and simulated driving tests as well as an on-road driving tests is essential before fitness for driving is certified in patients with dementia. There is also a need for their cognitive capacities and decision-making abilities both remote and split second to be assessed along with a test for dexterity. Vision and hearing ability also need to be tested
- Naturalistic evaluations as on-road testing or driving simulators may not adequately reflect a person's true capabilities. Elderly patients may be more anxious or more cautious when tested and may make mistakes. Older adults also may not be comfortable with an electronic driving simulator, preferring rather their own car 
- Driving sometimes may be the only source of joy or recreation for the patient and his means of transportation and contact with the outside world. It is desirable to avoid premature withdrawal of driving privileges if at all possible. Individual dignity and quality of life must be seriously addressed in any public policy or individual decision to revoke driving privileges. There is also a need for the evaluation of driving ability every 6 months and also a special sticker on the car that the driver has dementia
- The most challenging assessment and decision lies when the patient is questionably or only having mild dementia. The dementia severity, family report, and performance on certain neuropsychological tests are factors that should serve as screening factors and this must be supplemented by a driving assessment by a professional driving instructor. The lack of clear guidelines and research in this area is also a clear problem that raises the ethical dilemmas in this area. Clear guidelines would enable all practitioners to follow the same algorithms when it comes to making these decisions and interindividual variability in certification shall be eliminated. The assessment of the severity of dementia is paramount and so is the differentiation between mild cognitive impairment and dementia.
It is important that clear guidelines in this area from an Indian perspective be made and that the Indian Association of Geriatric Mental Health takes the lead in the same.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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