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Practical Experience-Based Approaches to Assessing Fitness to Drive in Dementia


Frank J. Molnar, MSc, MDCM, FRCPC, Canadian Institutes of Health Research (CIHR) CanDRIVE Research Team, Clinical Epidemiology Program, University of Ottawa Health Research Institute; Division of Geriatric Medicine, Department of Internal Medicine, University of Ottawa; Division of Geriatric Medicine, the Ottawa Hospital; REVTAR Research Group and CT Lamont Centre for Primary Care Research, Élisabeth-Bruyère Research Institute, Ottawa, ON.
Anna M. Byszewski, MD, FRCPC, CIHR CanDRIVE Research Team; Division of Geriatric Medicine, Department of Internal Medicine, University of Ottawa; Division of Geriatric Medicine, the Ottawa Hospital, Ottawa, ON.
Mark Rapoport, MD, FRCPC, CIHR CanDRIVE Research Team; Department of Psychiatry,
University of Toronto; Sunnybrook Health Sciences Centre, Toronto, ON.
William B. Dalziel, MD, FRCPC, Division of Geriatric Medicine, Department of Internal Medicine, University of Ottawa; Division of Geriatric Medicine, the Ottawa Hospital; the Regional Geriatric Program of Eastern Ontario, Ottawa, ON.

There may be up to 1.5 million persons with dementia who are driving in North America. In many jurisdictions, physicians are mandated to assess and report fitness to drive in such patients. Lack of knowledge of patients’ driving status does not protect physicians from lawsuits. There is a paucity of research to aid physicians in the assessment of fitness to drive in persons with dementia. Guidelines recommend the Mini-Mental State Examination, the clock-drawing test, and Trails A and B but lack evidence-based instructions regarding how to interpret such tests. This article provides experience-based approaches to the assessment of fitness to drive in dementia as well as an approach to disclosure of the findings to patients.
Key words: dementia, Alzheimer, driving, family physicians, cognitive testing.