Johns Hopkins Health Alert — When Is It Time To Stop Driving?

I have great news! I had my 6-month checkup with my neurologist this past Friday. Quite a good visit. My mini-mental status exam improved by 3 points from earlier this year. Obviously, he is pleased as is Pam and I. After much discussion, he feels the gardening has helped a lot but more importantly, he emphasized the combination of Namenda and Aricept as being the main factor in my improvement. "Your underlying problem is still there but you are improving slightly from the plateau you’ve been on. I still have cogwheeling (The ‘pullback,’ jerky or ratcheting effect in an arm or leg that the doctor perceives when moving a patient’s rigid limb, thought to be related to tremor superimposed on limb rigidity), tremors, etc. He asked if I wanted to be placed on anti-Parkinsonian drugs to which I responded no. If I can avoid any extra drugs at this time the better it is. He agreed and decided to wait until it’s absolutely necessary to take them. So, gardening it will be along with watching food intake and increasing exercise!

Johns Hopkins Health Alert     When Is It Time To Stop Driving?

For most of us, driving is not only a symbol of our independence, but a practical tool of everyday living. So it’s no surprise that taking away a patient’s driving privileges is among the most difficult and potentially divisive decisions for the Alzheimer’s caregiver. In this Health Alert, Dr. Peter V. Rabins, Medical Editor of The Johns Hopkins Memory Bulletin, answers questions about driving and the Alzheimer’s patient.

Q. What signs should an Alzheimer’s caregiver watch for when determining a loved one’s driving competence?

A. While there are no set criteria for determining when a person with Alzheimer’s disease should be prevented from driving, there are warning signs. Keep in mind that in some states, driving privileges are based on the stage of the Alzheimer’s disease assigned by the physician.

The following are some common indicators that a person’s Alzheimer’s is making it difficult for them to respond safely while driving. Whenever you notice such problems, record the date and time when these behaviors occur, and discuss them with the person and his or her doctor:

• Not signaling for turns or signaling incorrectly
• Confusion at exits
• Hitting curbs when trying to park
• Parking inappropriately
• Driving at inappropriate speeds
• Delayed responses to typical and atypical situations
• Getting lost along a familiar route
• Getting unexplained dents on the car
• Confusing the brake and gas pedals
• Stopping at a green or flashing yellow light
• Having near misses with pedestrians and other cars
• Getting citations for poor driving
• Having accident(s)

Q. When should a driving evaluation be sought?

A. If any of the above has occurred and the person will not voluntarily give up driving, then a formal evaluation by the motor vehicle bureau or private driving instructor should be sought. Most caregivers will restrict driving after a loved one has accumulated one or more of the warning signs listed above but many people with Alzheimer’s disease will deny any problems and, when asked to limit their driving or stop driving altogether, will be highly resistant. Some people who have the early stages of Alzheimer’s recognize that they are having changes and go in for testing on their own initiative. I always encourage and support this.

An evaluation by a driver rehabilitation specialist can be of great value in helping to make the difficult decision of taking away the car keys. A driver evaluation will assess the components of driving that may be compromised by this progressive condition. Areas assessed should include: attention, processing speed, visuospatial functioning, decision making, judgment, planning, memory, and behavior.

To find a certified driving rehabilitation specialist in your area who can perform such an evaluation, contact Driver Rehabilitation Specialists, ADED, 2425 N. Center Street #369, Hickory, NC 28601; Tel: 828-855-1623, or toll-free in the U.S. and Canada: 866-672-9466. Email: www.driver-ed.org

Warmly………David

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