Driving, if you have gotten used to it, is almost like a habit. For many, being prevented from driving may even be as traumatic as forced retirement – it takes away an important social lifeline while for some, the loss could be that of an economic lifeline.
But driving is a skill that like many others is affected by ageing. Reflexes slow down and the judgement misses its sharpness. It is much worse if the driver has dementia – a condition which affects memory, behaviour or judgement.
What is dementia?
Dementia is not a disease in itself as say, Alzheimer’s. It is a non-specific syndrome in which few areas of brain function may be affected such as memory, language, problem solving and attention. This syndrome attacks the higher mental functions of the patient initially. Eventually, in the later stages, the person may not know what day of the week, month or year it is, he may not know where he is, and might not be able to identify the people around him. Though dementia is significantly more common among the elderly, it can affect adults of any age.
Three signs of dementia
• Memory Loss: The affected person may forget his way back home from the shop or office, forget names and places. He may find it hard to remember what happened earlier on during the day.
• Moodiness: As parts of the brain that control emotion become damaged, the patient may become more and more moody. Fear and anxiety affect moods too as he slowly realises the difficulties he is facing.
• Communicative Difficulties: The affected person would find it harder to talk read and/or write. As dementia progresses, he may not be able to look after himself and even everyday chores would be a herculean task.
The test of driving
Even with dementia, a large number of people may still continue to drive safely and even pass a driving test. The challenge for doctors and caregivers is to identify those patients with dementia for whom driving may be unsafe, from those who may yet continue to drive safely.
• Memory screening tests like the Clinical Dementia Rating (CDR) or the Mini Mental State Examination (MMSE) could be used by doctors as a starting point. When combined with other risk factors, a more accurate prediction of driving performance is possible.
• The caregiver’s assessment of the patient’s driving is an important pointer.
• A ‘marginal’ or ‘unsafe’ rating predicts hazardous driving.
• A history of traffic-rule violations or of accidents also indicates driving risk.
• Voluntarily reduced mileage by the patient and self-reported avoidance, at nights or in the rain for example, also predict a higher risk.
• Aggressive or impulsive personality traits identify those who should avoid driving.
The presence of several such risk factors in a patient clearly favours a driving ban. Patients should be advised accordingly and alternative arrangements should be made. For those who still wish to continue driving, a formal re-evaluation of their driving performance could be suggested. In our country, the legal position for such situations may have to be strengthened. Conversely, there may be little point in preventing a patient with mild dementia who does not have any of the risk factors mentioned above, to drive. Close monitoring of their driving skills and a six-monthly reassessment may be all that is required.