Neurology Book

Cognitive Disorders

  • Elderly Drivers with Cognitive Impairment

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Elderly Drivers with Cognitive Impairment

Aka: Elderly Drivers with Cognitive Impairment, Dementia Evaluation in Older Adult Drivers
  1. Epidemiology
    1. Dementia doubles crash risk (esp. fatal crashes)
    2. Drivers license active in 30% with Dementia
      1. Lloyd (2001) Can J Occup Ther 68:149-56 [PubMed]
  2. History suggestive of unsafe driving
    1. Crashes, near-crashes, or dents in the car body
    2. Disoriented in familiar neighborhoods
    3. Missed or misinterpreted street signs
    4. Lack of awareness of surrounding traffic
    5. Misjudging speed, distance, or driving situations
    6. Frequent traffic violation citations or tickets
  3. Risk Factors: Medications that impair driving ability
    1. Benzodiazepines
    2. Opioid Analgesics
    3. Antihistamines
    4. Drugs causing Hypoglycemia (e.g. Insulin, Sulfonylurea)
    5. Ray (1993) Clin Geriatr Med 9:413-38 [PubMed]
  4. Evaluation
    1. Sensory evaluation
      1. Visual Acuity
      2. Hearing acuity
    2. Motor evaluation
      1. Get Up and Go Test
      2. Motor Strength and range of motion
    3. Cognitive Testing
      1. Clock Drawing Test
      2. Trails B Test >180 seconds
      3. Clinical Dementia Rating Scale (CDR)
  5. Other evaluation tools
    1. Indications
      1. Initial evaluation of driving safety
      2. Repeat testing every 6-12 months in high risk patient
    2. Evaluators
      1. Road Testing
      2. Occupational Therapy
      3. In-person driver's license renewal
        1. Referral to department of motor vehicles
  6. Resources
    1. American Occupation Therapy Association
      1. http://www.aota.org/olderdriver
    2. American Medical Association
      1. http://www.ama-assn.org/go/olderdrivers
    3. NTSA Injury Prevention in Older Road Users
      1. http://www.ntsa.dot.gov/people/injury/olddrive
  7. References
    1. Carr (2006) Am Fam Physician 73:1029-36 [PubMed]
    2. Fox (1997) J Am Geriatr Soc 45:949-53 [PubMed]
    3. Kayaiya (2000) Postgrad Med 107:229-36 [PubMed]

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