From the Alzheimer's Association National Newsletter, Volume 15, no. 3, Fall 1995.

Driving is a complex activity that demands quick reactions, alert senses and split-second decisions. For the person with Alzheimer's, driving inevitably becomes difficult. "I was able to drive for a while, but recently had to stop," says Thomas Cho, who was diagnosed with Alzheimer's nearly three years ago. "Giving up driving was one of the hardest things I've ever had to do."

In our culture, driving is synonymous with adulthood and independence. "It's devastating to be told you are no longer capable of driving'," says Jonathon Trobe, M.D., a neurologist and researcher at University of Michigan's Transportation Research Institute. "That's why many individuals with Alzheimer's, particularly men, are reluctant to leave the driving to someone else."

There are conflicting opinions about whether someone with Alzheimer's should drive. But a diagnosis of Alzheimer's does not mean the person has lost all abilities. "Drivers rely on visual and spatial sensitivity, which is not immediately impaired in all persons with Alzheimer's," says Trobe. "A diagnosis of Alzheimer's doesn't mean a person should be automatically stripped of their license."

Bernadine Wagner, who was recently diagnosed with Alzheimer's, feels comfortable driving locally, but doesn't travel far from home. "I don't have any difficulty driving," she says. "I'm very careful and only go to familiar places."

How long can someone with Alzheimer's continue to drive safely, and how do caregivers know when to discourage driving? According to Trobe, researchers are working to develop quantifiable tests (e.g., driver simulation) that eventually will help determine whether or not a person is able to continue driving. "Until then, they can only be monitored by caregivers," says Trobe.

"When driving becomes a safety issue, that's when it needs to stop," explains Anne Lilla, director of family services, Detroit Area Chapter of the Alzheimer's Associaton. "Caregivers need to continually evaluate the individual's driving ability and be able to take the keys away before the person become a danger to themselves or others." According to Lilla, caregivers should watch their driver for the following "warning signs" of unsafe driving:

* is unable to locate familiar places
* does not observe traffic signs or drives at an inaappropriate speed
* makes poor or slow decisions in traffic
* becomes angry, frustrated or confused while driving

"One or several of these behaviors indicate that it's time for the person with Alzheimer's to immediately stop driving," says Lilla. The following strategies can help ease a person's transition from driver to passenger:

Acknowledge the loss. "Giving up the keys represents a loss of independence an mobility, traits that individuals with dementia are striving to maintain," says Trobe. Lilla suggests caregivers be especially sensitive and supportive during this awkward period. "The former driver may be depressed and angry," she explains. "Be reassuring and try to involve the person in other aspects of travel. Put them in charge of the radio and temperature controls and ask them to watch for important signs."

Arrange for transportation. People, including individuals with dementia, often drive out of necessity. "Reassure the person with Alzheimer's that a ride will be available whenever they need to go somewhere. Plan ahead, so that rides can be arranged early and drivers secured. And make ceretain that the person doing the transporting is the one who actually drives. "There's not much you can do if you're sitting next to an impaired driver," reminds Lilla, "You have to be the one driving."

Solicit the support of others. Most people will listen to their doctor. Ask your physician to advise the person with Alzheimer's not to drive. "My mother's doctor actually wrote a prescription that said, 'no driving'," says caregiver Jan Wachter. "She respects the 'doctor's order' and no longer argues with me over the keys." Relatives, a trusted friend, or even an insurance agent can reinforce the message that driving can be dangerous.

Make the car less accessible. Keep the car keys with you at all times and leave your "extra set" with a neighbor. If the car is not used, disable it (by removing the distributor cap) or park it down the street, where the person with Alzheimer's won't see it. If the car is not needed, sell it. The money saved in insurance premiums, gas and maintenance could cover the costs of special transportation arrangements and taxi cab rides.

Take the test. You may need to go directly to your state department of motor vehicles for help. Explain to them your concerns and ask them to retest the driver. It is often difficult for a person with dementia to pass the required tests. As a last resort, in most states, you can even request that the person's license be revoked. The state may require a letter from a physician that certifies that driving is no longer an option. But don't assume that taking away a license will necessarily discourage driving. You'll still have to make certain the person with Alzheimer's doesn't have access to a car.

Be firm. Avoid arguments, and long explanations for why driving is no longer an option. Focus on other activities that the person can still enjoy. Formulate a driving plan early on and ask for assistance from family and friends.

From the Alzheimer's Associaton National Newsletter, Volume 15, no. 3, Fall 1995