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IOWA CITY - Updated guidelines offer recommendations on when people suffering from dementia should stop driving.
Not everyone with Alzheimer's disease or other dementia needs their car keys taken away, at least in early disease stages, said Dr. Matthew Rizzo, University of Iowa neurology professor.
"If you have Alzheimer's disease, ultimately you will have to stop driving," Rizzo said. "But you don't want to take away a driver's privileges just because you suspect they have a problem."
Rizzo was senior author of the new guidelines issued today by the American Academy of Neurology.
Doctors can use the guidelines to help families decide when their loved ones should stop driving.
The situation isn't always clear-cut, Rizzo said, with as many as three in four patients with mild dementia able to pass an on-road driving test.
More than 5 million Americans have Alzheimer's, the brain degeneration that robs a patient's memory and ability to care for themselves. That number is climbing as the population ages.
Lead author Dr. Donald Iverson, with California-based Humboldt Neurological Medical Group, Inc., noted that doctors should discuss the guidelines soon after diagnosis with the patient and caregivers. Restricted driving can affect the patient's quality of life and lead to depression, he said.
The guidelines include using a test known as the Clinical Dementia Rating scale to help identify potentially unsafe drivers.
That rating scale, along with information from caregivers, can help determine the severity of a patient's dementia.
The authors noted that a patient's self-rating is not a reliable indicator of safe driving ability.
Caregivers' concerns that a patient's driving had become unsafe were often accurate, however, and should be part of the assessment, they said.
Under the guidelines, warning signs of unsafe driving can include:
* driving fewer miles;
* moving violations;
* avoiding certain situations, such as driving at night or in the rain;
* aggressive or impulsive personality traits.
Since the last set of guidelines were issued in 2000, numerous techniques, such as newer driving simulators and cognitive tests, have become available, resulting in a number of studies.
The UI's National Advanced Driving Simulator, for example, has the world's highest fidelity research driving simulator, the NADS-1.
Rizzo said authors combed through thousands of research articles to develop the guidelines.
Some states require doctors to report medical conditions that affect driving to the state. Iowa does not have a mandatory reporting law, but if a patient poses a risk and continues to drive, the doctor can report that patient to the state.
For more information on Alzheimer's disease, see: www.alz.org.