Common Questions

• Who decides when an individual with Alzheimer’s disease or other dementia should no longer drive?
• What is the role of the person with Alzheimer’s disease in making the driving decision?
• What are the implications of mandatory reporting by physicians of an Alzheimer’s diagnosis to a state’s department of motor vehicles?

Background Information
The declining cognitive abilities of an individual with Alzheimer’s disease will ultimately lead to the necessity of driving restrictions. It is difficult to determine when restrictions are needed, however, because little solid evidence exists linking various stages of dementia with driving behavior. Never-the less, at some point in the progression of the disease, driving performance errors will present a safety risk to both the individual and the public.

Association Positions
Although the Alzheimer’s Association does not have an official policy statement regarding driving and dementia, the National Alzheimer’s Association Ethics Advisory Panel has made the following recommendations regarding restrictions on driving:

• A diagnosis of Alzheimer’s disease is never itself a sufficient reason for loss of driving privileges.
• If an Alzheimer patient’s driving is impaired, driving privileges must be limited.
• Driving privileges must be withheld when the individual poses a serious risk to self or others.
• The person with dementia, if competent, should participate in decision making regarding driving restrictions . Ideally, a privilege is never limited without offering the affected person ways to fill in the gaps and diminish any sense of loss. The affected person should retain a sense of freedom if possible, and an “all or nothing” approach can and should be a voided. For example, if some driving privileges can continue, they may be limited to daytime driving in certain areas. If a person needs to stop driving altogether, then he or she can express a preference on transportation options. Informed and caring family members can successfully implement compromise, especially when the per-son with Alzheimer’s has insight into diminishing mental abilities and loss of competence. Appropriate limits to driving can often be mutually agreed upon through open communication among the Alzheimer-affected person, family members, and health care professionals. Individual responses to proposed limits will vary from immediate acceptance to strong resistance. To encourage acceptance, the individual who agrees to limits should be assured that others, such as family members, will provide transportation . Indeed, family members can often avoid conflict with the affected individual by identifying and implementing safe alternatives.