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 he American Academy of Neurology has issued guidelines
to help determine whether people with Alzheimer's disease should
continue driving. The guidelines are published in the June 27
issue of Neurology, the scientific journal of the American
Academy of Neurology.
 "Driving
is often necessary for people to remain independent in our society,
but accidents are a major cause of injury and death," said
neurologist Richard Dubinsky, MD, coauthor of the guidelines.
"The American Academy of Neurology developed these guidelines
to help answer the question: Does driving by people with Alzheimer's
pose a significant traffic safety problem?"
To develop
the guidelines, researchers searched medical databases and literature
for scientific studies published in this area. They found 14
relevant studies in three categories: studies that looked at
the rate of accidents in drivers with Alzheimer's; studies that
involved on-the-road or simulated performance tests; and studies
that evaluated how well people with Alzheimer's can process what
they see when driving.
The researchers
looked at the risks of driving for people with Alzheimer's and
compared them to the risks found in other groups of drivers,
such as 16- to 21-year-olds or people driving under the influence
of alcohol but within the legal limit.
"Drivers
with Alzheimer's disease have a substantially increased rate
of accidents and driving performance errors," said Dubinsky,
who is an associate professor of neurology at Kansas University
Medical Center in Kansas City. "They pose a significant
traffic safety risk, and should be advised not to drive. Any
recommendations by health care providers about driving by people
with Alzheimer's disease must comply with state laws and be made
in conjunction with evaluation of the individual patient and
with the input of their care-giver."
The guidelines
state that driving performance evaluations should be considered
for people with slight cognitive impairment, or a Clinical Dementia
Rating of 0.5.
This state
is characterized by consistent slight forgetfulness that is "benign,"
or does not interfere with everyday activities. It also involves
slight impairment in activities at home and with hobbies. Patients
with slight cognitive impairment are fully capable of handling
their personal care needs such as dressing and hygiene.
These patients
have an increased risk of accidents when compared to other elder
drivers, but their risk is similar to that of 16- to 21-year-olds
or to drivers with a blood alcohol level of less than .08, which
is the lowest limit imposed in the United States.
The guidelines
also recommend that these patients be reassessed every six months
because of the likelihood that their level of dementia will increase
to CDR 1 within a few years.
The guidelines
also recommend areas where more research is needed.
"More
research should be done to determine whether there are groups
of patients with dementia (CDR 1) who can drive safely, or can
drive safely with certain restrictions, such as non-highway driving
or driving within a limited geographic area," said Dubinsky.
The guidelines
also call for research into the type and severity of accidents.
"It may be possible that if there are typical accidents
that involve drivers with Alzheimer's disease, driving limitations
or technological solutions could be used to decrease the risk
of accidents," Dubinsky said. 
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