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Does Dementia Mean It’s Time To Hand Over The Car Keys?

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Does Dementia Mean It’s Time To Hand Over The Car Keys? about undefined
Driving is complicated. And dangerous. Roughly 43,000 people died in car crashes in the U.S. in 2021. And for people with mild cognitive impairment (MCI), the joy of driving that was once a symbol of independence can become a point of contention with family members and friends. It begs the question, when should someone with memory loss or MCI stop driving? To answer this question, we must consider just what happens in the brain when you get behind the wheel. Driving is an activity that requires the use of both left and right hemispheres of the brain. Each brain hemisphere has four sections, called lobes: frontal, parietal, temporal, and occipital.
  1. Occipital – center for visual-spatial processing, movement, color recognition
  2. Temporal – the primary auditory cortex, interprets smells and sounds
  3. Parietal – processes sensory information, coordinates spatial relations, movement and visual orientation, visual perception, and information processing
  4. Frontal – problem solving, reasoning, motor skills, impulse control, planning, and regulating social behavior.
Driving requires the use of all four of these lobes of the brain. For example, your visual-object system (occipital and temporal lobes) processes images so you can distinguish cars, bicycles, motorcycles, and pedestrians. The visual-spatial system (occipital and temporal lobes) tells you where cars, bicycles, and pedestrians are on the road, how fast they’re moving, and where they’ll be a few seconds later. Your attention system in your parietal lobes and auditory system in your superior temporal lobe keep you alert to car horns, sirens, and other signs of danger. The decision-making system in your frontal lobes uses visual, auditory, spatial, and motion information to decide how fast you should be going, or whether you need to turn. The motor system of your frontal lobes translates those decisions into how hard you press the pedals, and whether your hands are turning the steering wheel. Then, you must consider what happens consciously in your brain when you’re driving, versus what happens subconsciously—all the actions you perform that you’re not fully aware of.

Conscious Vs. Subconscious Driving 

You may be amazed at the fact that you do all these activities and process all this information while you drive – even while you sing along with the radio, listen to a podcast, or speak with your friend in the passenger seat. The reality is that most of what you do is routine and automatic once you learn to do it. There’s significant evidence that most of your daily routines are conducted almost subconsciously without much conscious thought on your part. That’s why if you become distracted while you’re driving, you may not even remember passing familiar landmarks. You’re on autopilot. Under duress, however, your conscious mind takes over. When you drive in a snowstorm or a torrential downpour, or on icy roads, you devote your entire conscious mind to your driving. You tune out the radio—or turn it off— pause the podcast or quit talking with your friend. But what about when you’re driving and suffer from cognitive impairment?

Driving With MCI Or Alzheimer’s Disease 

Alzheimer’s and other dementias can impact all four lobes of the brain. People with Alzheimer’s may experience slow visual, auditory, attention, and decision-making processes that can make driving unsafe. As you probably know, Alzheimer’s starts silently and unobtrusively without very many symptoms. It may affect thinking and memory but still allow normal function. That’s the mild cognitive impairment stage. When the disease affects more of one’s cognitive function, it’s at the dementia stage. One study found that folks with Alzheimer’s had more than double the car wrecks per year as healthy people of the same age – 0.09 crashes per year compared with 0.04 crashes. Another study showed that people with mild cognitive impairment and very mild dementia were impaired to the same level as 16- to 20-year-old drivers. However, we allow new drivers to drive with few to no restrictions. Not every person with Alzheimer’s disease or MCI needs to stop driving, however. Alzheimer’s has stages that can last for different lengths of time in different people, and a lot depends on the severity of the disease and which cognitive abilities are affected.

When Should You Stop Driving? 

The American Academy of Neurology established standards to help professionals decide when those with Alzheimer’s disease or MCI should stop driving. The questions to ask include:
  • Do caregivers consider you to have marginal or unsafe driving skills?
  • Do you have a history of citations and/or crashes?
  • Do you drive fewer than 60 miles per week?
  • Do you avoid driving in certain situations?
  • Are you aggressive or impulsive while driving?
  • Is your cognition impaired on normal cognitive tests?
  • Do other factors impair your driving, such as alcohol or medications that cause mental impairment, sleep disorders, visual impairment, or motor impairment?

My Takeaway 

At some point, all of us, whether we have Alzheimer’s disease or not, will have to give up driving a vehicle. Eventually, driving is just not in our best interests or the interests of those around us. It’s a sad day for most people when it comes time to hand over the keys. My advice is to work with your family members and friends to ensure that everyone is safe behind the wheel. For example, if you’ve been diagnosed with a memory disorder, ask one of your adult children or a friend to ride in the car with you monthly. If your children or friends are comfortable with your driving, you’re probably a safe driver. Note: Put the focus on safe, undangerous driving... not on missing a turn or getting lost in a strange place. This may raise the question... What if your family feels your driving is unsafe, but you feel it’s safe? In this case, you may consider taking a driving test to prove you’re a safe driver. Or you could implement some guidelines such as no night driving, or no driving to new places, or even no driving without a trustworthy companion. The good news is that now, when the day comes to finally hang up your keys, there are so many rideshare services available that getting around on your own will still be possible.

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