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Tuesday, April 28, 2009

Giving up the Car Keys with Alzheimer’s

Family of Loved Ones Must Make Tough Decisions

As Alzheimer's is increasingly diagnosed in its earliest stages, scientists are hard at work designing tests to reveal when it's time for people with early Alzheimer's disease to stop driving.

Knowing when a loved one is poised to become a danger is one of a family's most wrenching decisions.

Keep in mind that much of the country lacks public transportation, so taking the keys too soon restricts independence for someone who otherwise may function well for several years.

"That's a real cost to the individual and family and society," says Jeffrey Dawson of the University of Iowa. "You have to have some sort of trade-off between the individual's independence along with the safety of the driver and with other people on the road."

Specialists report that patients gradually cut back their driving, diverting away from busy freeways, night trips and left-turn intersections. Alzheimer's Association adviser Sue Pinder, 58, recently stopped driving in big cities, even though it means fewer trips to visit her daughter in Dallas.

After being diagnosed with Alzheimer’s in 2004, Pinder signed a form designating her husband to decide when she'll quit driving for good. The GPS system he bought for her last birthday has helped Pinder navigate unfamiliar streets when the couple recently moved to be near another daughter.

"That's helped a lot where I don't have to worry, I can concentrate on my driving and not the directions," Pinder says.

To help similar patients, Dawson's team developed an intricate behind-the-wheel exam: A 35-mile drive through rural, residential and urban streets in an accessorized Ford Taurus that, much like an airplane "black box" does, records just about every action the driver makes. Video cameras were positioned to show oncoming traffic, too.

To compare how older drivers without dementia handled the same trip, researchers recruited 40 people with early-stage Alzheimer's who still had their driver's licenses to take the road test.

As reported in the journal Neurology, the results are striking. The Alzheimer's drivers committed an average of 42 safety mistakes, compared with 33 for the other drivers.

Lane violations — swerving or hugging the centerline as another car approaches — was where the Alzheimer's drivers performed 50 percent worse.

With increasing age, overall errors increased an extra 2 1/2 mistakes for every five years of age, whether or not the driver suffered from Alzheimer's.

But Dawson, a biostatistics professor, stressed that some Alzheimer's patients drove just as well as their healthier counterparts. Here's the key: Researchers also examined whether any of a battery of neuropsychological tests that were previously administered accurately predicted who would drive worse - and some did.

Failing simple memory tests didn't make a difference. Standard neurological tests of multitasking abilities did, ones that evaluate how people's cognitive, visual and motor skills work together to make quick decisions. Examples include showing patients geometric figures for a few seconds and instructing them to draw the shape from memory, or drawing paths between a sequence of numbers and letters.

Dawson said that Alzheimer's patients who scored average or better on those types of written tests were likewise no worse behind the wheel than other older drivers - but those who scored worse than average committed about 50 percent more errors on the road.

Although more research is needed, the ultimate goal is a simple doctor's-office exam to help determine when patients should give up the keys.

About 600,000 elderly adults discontinue driving for health reasons every year, according to the National Institute on Aging. But there's a dearth of clear guidance for the nearly 2 million people estimated to be in Alzheimer's early stages, and the disease is expected to skyrocket in two decades as the population ages.

State laws differ on when aging drivers must pass a road test for a license renewal, but they seldom address specific diseases; California mandates the reporting of Alzheimer's diagnoses so driving can be assessed. The Alzheimer's Association informs families of unsafe driving warning signs.

But patients often vehemently deny that they're a hazard as Alzheimer's worsens, according to Dr. Gary Kennedy, geriatric psychiatry chief at New York's Montefiore Medical Center.

"I can be the bad guy," he tells families, who often report patients to the Department of Motor Vehicles for a driving test or advises relatives to disable the car.

"Giving up the car is not like going into the nursing home," Kennedy advises patients, trying to recruit relatives or friends to schedule rides. "If as a society we recognize this as a danger, we need to help them compensate."

Along with motor vehicle safety, driver education helps ensure the safety of Americans. Whether you're getting your Commercial Drivers License, your Learner's Permit, or your Motorcycle License, America's Driver's License Headquarters is

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