"Understanding Dementia"

This is an excerpt from the book Understanding Dementia, which is meant to be a practical manual for primary care physicians and other health care professionals. Dementia exists when impairment with cognition Cognition
The mental processes associated with knowing and understanding thoughts and perceptions about one's environment. (e.g. memory Memory
The ability to process information that requires attention, storage, and retrieval., language, calculation) is severe enough to interfere with function. Driving is a high order function, and it is discussed in Chapter 7, as an aspect of the assessment of a patient's competence Competence
A person’s ability to make informed choices..

Competence for driving is a difficult issue, as many patients perceive driving as necessary for independence. When a person with dementia has their driving privileges withdrawn, it is not unusual for their non-driving spouse to essentially be sentenced to house arrest. The FAST (Table 5.4) can be very valuable here, as those scoring 4 or more should probably not drive. The patients should be questioned with regards to driving habits, accidents, and episodes of disorientation Disorientation
A lack of awareness or confusion about time, place, or personal information.. The physical examination should concentrate on vision, attention, psychomotor speed, and visuospatial skills. Families can be invaluable allies when driving is a risk. When patients refuse to stop driving, the legal standard for the physician's obligation to report a patient suspected of unsafe driving varies by jurisdiction. Our practice is to write the Registrar of Motor Vehicles, who will request the patient to appear for a road test, although depending on the cultural and legal context, and personal preferences, some physicians find this objectionable. Patients who successfully complete the test can continue driving. In addition, many rehabilitation centres run programs for the assessment of driving skills. Most of the assessments do not accurately differentiate dementia patients who will have accidents from those who do not. If an evaluation tailor-made for dementia patients is available it should be used. Otherwise the physician will need to rely on their judgement and experience. Some jurisdictions have experimented with options more flexible than the polar opposites of either unlimited driving privileges or no driving privileges. Various classes of restrictions, in terms of place, time of day, and presence of a companion have all been imposed.

 © Rockwood & MacKnight, 2001. p.85

Taken from Understanding Dementia: A Primer of Diagnosis Diagnosis
The process by which a physician determines what disease a patient has by studying the patient’s symptoms and medical history and by analyzing any tests performed (blood, urine, brain scans, etc.). and Management
© Kenneth Rockwood & Chris MacKnight, 2001
Chapter 7, pp 119-120