Alzheimer's disease and other types of dementia can significantly impair driving skills. The impairment can start as early as MCI (Mild Cognitive Impairment), and certainly progresses rapidly during early stages of dementia.
Cognitive impairments that occur with any type of dementia will cause the individual to lose the ability to drive safely. Dementia also causes the individual to lose their ability to self-regulate, so they are unable to notice their own impaired driving.
In the US, driving is strongly associated with a person’s ego – we value our ability to go where we want, when we want. While most older adults give up driving when they are no longer safe, some are very resistant. That is true of most individuals with dementia. Too many times after completing a driving assessment and determining the driver was no longer safe to drive, they have argued they made mistakes during the driving assessment because “I was not driving my car” or denied the mistakes altogether.
Riding in the car with individuals during my assessment has given me a different perspective and sensitivity of safe vs. unsafe drivers. Since I sit in the back seat and take notes during the assessment, I have come to value the skill of the driving instructors I work with, that they have the ability to keep us safe and accident free, while allowing the driver to demonstrate their normal driving habits.
How Symptoms Affect Driving
The symptoms of Dementia do vary from patient to patient, and they progress in the disease in different ways. But even in mild cases, common symptoms such as impaired visual perceptual skills (depth perception), impulsive decisions, and slowed physical and mental responses will lead to unsafe driving
Most Common Mistakes
- Turning immediately into the next lane when given the instruction, "Make a lane change to the left when it is safe"
- Mixing the gas and brake pedals
- Driving too close to other cars, pedestrians, cement medians and curbs
- Making wide turns onto the opposite side of the street
- Attempting a turn from the wrong lane
- Making a left turn with oncoming traffic
- Being confused with signal lights and stopping at a green light, or proceeding on a red light
- Rolling through stop signs (I know none of you do that, right??)
How You Can Help
You need to discuss the individual’s driving with family members as well as their physician. Research from The Hartford and MIT AgeLab states that typically the individual wants the spouse or a favorite son or daughter to have this first discussion with them. If you are not be able to convince the individual they are no longer safe to drive, it is important to enlist the help of others. Hiring an Occupational Therapist, who is a Driving Rehabilitation Specialist, to provide a driving assessment, and letting the Occupational Therapist advise the individual that it is time to retire from driving may be a better option than for you to make that determination.
Sometimes people are able to drive, for a period of time, with self-restrictions:
Driving during the day to avoid rush hour traffic
Driving only on sunny, clear days
Driving only to familiar places
If your family member refuses to stop driving, in spite of unsafe driving skills, you may need to take further action. You can take the car keys away, but if you aren’t able to locate every set, they may still sneak out and drive. You need to be aware- you cannot take the keys away without a Durable Power of Attorney in place.
You have the option of disabling the car, but often I’ve seen the driver call a local mechanic and get the car fixed. So if you choose to disable the car, you need to write a note to the mechanic, and tape it to the engine of the car with a note stating to call you before they “fix” the car.
If a family member has power of attorney, you can take the car away or sell the car. You also have the option of calling the local Department of Motors Vehicles, and reporting your concerns. In many states you can report anonymously, but I’ve heard many stories of sympathetic DMV employees letting the individual know who reported them, even though they asked to be anonymous.
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