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May 2010

New Driving Guidelines from the AAN and the AMA

On April 12, the American Academy of Neurology (AAN) issued a new guideline to help determine when people with Alzheimer’s disease or another type of dementia should stop driving. The guideline recommends that physicians use the Clinical Dementia Rating (CDR) scale to identify those with dementia at an increased risk of unsafe driving, along with a caregiver’s rating of a patient’s driving ability. Physicians should also consider the individual’s driving history, reduced driving or avoidance of driving, Mini-Mental State Examination scores of 24 or less, and aggressive or impulsive personality characteristics.

The guidance is outlined in “Practice Parameter update: Evaluation and management of driving risk in dementia” in the April 20 issue of Neurology and online at www.neurology.org.

While evidence shows that patients with mild dementia are a higher risk for unsafe driving, recent studies find that 41-76 percent of subjects with mild dementia can pass on-road driving tests, wrote the authors of the AAN guidelines. By weighing the various factors outlined by the AAN, clinicians may be able to more accurately predict driving performance.

In March, the American Medical Association (AMA) released the “Physician’s Guide to Assessing and Counseling Older Drivers” to help protect the lives of older drivers and make roads safer. The AMA noted that drivers age 75 and older are involved in significantly more motor vehicle crashes per mile driven than middle-aged drivers, and that older drivers are more likely to suffer a fatal injury in the event of a crash.

The AMA guide, developed in cooperation with the National Highway Traffic Safety Administration, covers screening, assessing functional abilities, and handling evaluations and referrals, as well as conditions and medications that may impact driving. The guide, and resources for older adults and caregivers, can be found online at www.ama-assn.org/go/olderdrivers.