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ARTICLES: B. R. Ott, W. C. Heindel, G. D. Papandonatos, E. K. Festa, J. D. Davis, L. A. Daiello, and J. C. Morris A longitudinal study of drivers with Alzheimer disease Neurology 2008; 70: 1171-1178 [Abstract] [Full text] [PDF]

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A longitudinal study of drivers with Alzheimer disease

Steven Mandel MD, Edward A. Maitz, PhD   (22 September 2008)

Reply from the authors

Brian Ott, William C. Heindel, George D. Papandonatos, Elena K. Festa, Jennifer D. Davis, Lori A. Daiello, Providence, RI, and John C. Morris, St. Louis, MO   (22 September 2008)

A longitudinal study of drivers with Alzheimer disease 22 September 2008
Steven Mandel MD, Jefferson Medical College 900 Walnut Street, Philadelphia, PA 19107, Edward A. Maitz, PhD Send Correspondence to journal: Re: A longitudinal study of drivers with Alzheimer disease drmandel1979{at}aol.com Steven Mandel MD, et al.	The article by Ott et al. highlights the current concerns associated with driving privileges for older adults and patients with Alzheimer disease (AD). [1] The lack of clear national standards and the lack of cognitive tests that have been validated for driving skills present a professional dilemma for neurologists and other physicians who evaluate and treat patients with various neurological disorders. The decisions that physicians make can potentially impact a patient's ability to safely operate a motor vehicle. In the absence of clear regulatory statutes, many professional organizations and advocacy groups have developed position statements and recommendations regarding driving privileges for patients with neurological disorders. However, many physicians may not be aware that some states have laws that supersede the position statements of our professional organizations. Our review found six states that had mandatory reporting requirements. [2] While some states allow for confidential reporting, only a few states provide physicians immunity from legal action for filing a report. It is also important to recognize that patients with other forms of dementia (reversible and nonreversible) also pose a driving risk. This will become problematic as the life expectancy of the general population continues to increase. Moreover, older people often seek part-time jobs that involve transporting other people. There should be stricter guidelines for those who operate school buses, limousines, taxicabs, and similar service vehicles. Because driving is part of an occupational responsibility, patients are often unable to avoid situations that could add additional risks such as driving in inclement weather, driving at night, or transporting other individuals with disabilities. Like Ott et al., we recommend further research to empirically identify cognitive abilities that might put a patient at risk for driving. In addition, physicians should be provided with a validated screening battery to determine which patients might need more extensive neuropsychological testing or formal driving evaluation. We also recommend establishing federal guidelines to protect society from those who may be incapable of safely operating a motor vehicle. In addition, separate guidelines should be developed for those who are responsible for transporting others. Like Ott et al., we support periodic re-evaluations, particularly for patients with progressive neurological disorders. Finally, laws should be enacted to protect mandatory reporters. References 1. Ott BR, Heindel WC, Papandonatos GD et al. A longitudinal study of drivers with Alzheimer disease. Neurology 2008;70:1171-1178. 2. Tuckman H, Gordon G, Mandel S, Maitz E. Dementia and Driving: When Should You Put on the Brakes. Practical Neurology. June 2006, 18-22. Disclosures: The authors report no disclosures.
Reply from the authors 22 September 2008
Brian Ott, Alzheimer’s Disease & Memory Disorders Center Rhode Island Hospital–APC 6, 593 Eddy Street, Providence, RI 02903, William C. Heindel, George D. Papandonatos, Elena K. Festa, Jennifer D. Davis, Lori A. Daiello, Providence, RI, and John C. Morris, St. Louis, MO Send Correspondence to journal: Re: Reply from the authors bott{at}lifespan.org Brian Ott, et al.	We thank Drs. Mandel and Maitz for their interest in our study. They bring up a number of important public policy issues we did not address and which deserve thoughtful consideration by our government policymakers. We agree that further research is needed to inform physicians and policymakers on the best ways to limit drivers who are cognitively impaired without unfairly restricting their autonomy by premature termination of driving privileges. Furthermore, we feel that it will be important to subject any new driving policies to longitudinal empirical testing in order to assess their effectiveness and to refine those policies. The American Academy of Neurology (AAN) recently published a position statement on physician reporting of medical conditions that may affect driving competence, with which we agree. [3] As our society ages and our expanding population of older drivers becomes vulnerable to cognitive impairment, it will become increasingly important to bring these issues to the forefront of public discussions. References 3. Bacon D, Fisher RS, Morris JC, Rizzo M, Spanaki MV. American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence. Neurology 2007;68:1174-1177. Disclosures: The authors report no disclosures.