When an Alzheimer’s disease (AD) diagnosis is made, mobility may not be the first question or concern that arises for a patient, family member or caregiver. However, the degenerative nature of the disease inevitably forces patients and the care team to consider driving fitness and autonomy behind the wheel.
Alzheimer’s is the most common cause of dementia, and the number of patients with the diagnosis continues to increase. AD is most commonly associated with memory loss, but is a progressive disease in which multiple cognitive domains are affected, with each domain having the ability to impair driving fitness. In addition to loss of memory, AD can affect attention, visuospatial abilities, executive functioning, and language. These domains each play a role in a patient’s ability to continue to safely operate a vehicle.
As the number of patients diagnosed with AD and the number of patients driving vehicles both continue to increase, scientists have taken a closer look at the best methodologies to identify driving fitness in patients with degenerative cognitive disorders.
A 2016 study in the Netherlands looked at three assessment tools to develop a method of assessing fitness to drive for AD patients. Assessment tools included clinical interviews, neuropsychological assessment and driving simulators. Results garnered from the assessment tools were measured and compared to an on-road driving test, which is considered the gold standard for determining driving fitness, to identify which tool proved the best driving-fitness predictor.
The findings are encouraging. The three assessments were predictive of on-road driving performance. Neuropsychological assessments showed the highest level of accuracy, followed by the driving simulator and clinical interviews. The best predictor for driving fitness came when all three tools were used in conjunction with one another. Combining all three assessments yielded an overall accuracy of 92.7 percent in predicting fitness to drive in patients with Alzheimer’s disease.
Clinical teams may utilize these tools to advise patients, family and caregivers about fitness to drive as the disease progresses.
Not all patients with Alzheimer’s disease are unfit to drive. Currently, AD is being diagnosed in earlier stages of the disease, often affording patients years of safe driving after diagnosis. This means it is necessary to investigate driving fitness for patients with AD on a patient-by-patient basis, and fitness must be reassessed as the disease progresses. Although Alzheimer’s disease most commonly is associated with memory loss, additional cognitive functions are affected, which can negatively affect a patient’s ability to safely operate a vehicle.
According to the study, “A driver with AD might fail to recall road regulations and routes, may fail to oversee the infrastructure and perceive the distance to other vehicles, or may respond too slowly to the environment resulting in strategic and tactical errors, especially in non-automated situations.”
Although on-road assessment is the gold standard in determining driving fitness, growing numbers of patients diagnosed with Alzheimer’s disease make it increasingly difficult to assess every patient by this standard.
Utilizing clinical interviews, neurological assessments and driving simulators, clinical teams can evaluate driving fitness and identify areas of concern in a safe, controlled environment. These assessments can build on one another to help create an overall picture that is easier to share with patients and family members, who may be hesitant to admit when driving fitness has reached a critical low.
Citation: Piersma D, Fuermaier ABM, de Waard D, Davidse RJ, de Groot J, Doumen MJA, et al. (2016) “Prediction of Fitness to Drive in Patients With Alzheimer’s Dementia.” PLoS ONE 11(2): e0149566. doi:10.1371/journal.pone.0149566
Driving simulators have become a much more common tool in clinical assessments, providing valuable insights in safe and controlled environments. DriveSafety’s certified technicians work alongside clinical teams to develop clinical exercises and driving scenario that can measure various components of driving fitness, including underlying functional abilities in vision, cognition and motor control, as well as driving skills performance such as lane maintenance, safe-speed management, traffic navigation, hazard avoidance, identifying traffic rules and roadway signs, and reaction times. These components may help determine driving fitness, and provide insights into areas that need improvement and additional training for patients to maintain driving fitness and safe driving ability for longer periods of time after diagnosis. Technicians are available today to discuss options. Call to schedule an appointment.