For many caregivers one of the most difficult decisions to make when caring for someone who is memory impaired is whether to restrict their driving privileges. Taking away these privileges signifies the loss of independence and can place the responsibility of transportation on the caregiver and others. The person with Alzheimer’s disease may even feel threatened by losing this independence causing them to delay their decision to relinquish this privilege.

While many people who have early stage Alzheimer’s disease or other types of memory impairment are still quite capable of driving, the likelihood that they may be involved in an accident increases. If you are caring for someone that is memory impaired and is still driving you should evaluate his or her skill level frequently to determine whether they should continue. As a general rule of thumb it is best to err on the side of safety then to run the risk of injury.

Although persons with Alzheimer’s disease lose their intellectual functioning abilities at various rates and to different degrees, the continued driving of motor vehicles places them at considerable risk due to these losses. The persons intellectual functions (memory, thinking ability, communication skills, reasoning, judgment, and attention) are likely to be affected over a period of time and will become progressively worse as the disease is allowed to runs its course.

When it comes to deciding what to do with a loved one that you feel is potentially dangerous behind the wheel of a car you may not need to go any further then to contact the Transportation Cabinet in the state where you live. Most states have Medical Review Boards that are appointed to determine who is unsafe to operate a motor vehicle due to mental or physical disabilities.

There are usually specific guidelines and criteria for determining conditions, which may affect the safe driving of a vehicle. These conditions usually fall into the following categories:

A history of illness;

The severity of symptoms and the persons prognosis;

Complications arriving from multiple conditions;

Treatment and medication use, including effects and side effects;

Medical test results and various reports of laboratory findings;

Physician’s medical report and examination findings;

Physician’s findings and recommendations; and

Physician’s assessment and determination of other identified risk factors.

Other factors that may play into the decision of a Medical Review Board to restrict, deny, cancel or not issue an operator’s license include:

Categorically, the Medical Review Board usually identifies physical and mental conditions that warrant further evaluation and possible action. These conditions range from one’s cardiovascular abilities, endocrine, cerebrovascular, musculosketal, neurological, mental or emotional, respiratory, neuromuscular, vision and sensory functions.

One of the first likely areas of intellectual functioning to be affected is that of judgment. Mastering the skills of operating a moving vehicle requires coordination, precise judgment and the ability to make quick and constant decisions.

A person with Alzheimer’s disease may appear to be able to routinely operate a vehicle without complications, however, what isn’t apparent is that their decision making skills are becoming more impaired over time. Critical decision making judgments as to safe travel speeds, navigational maneuvers around steep or curved turns, as well as complying with highway instructions all become major challenges.

Disorientation and memory loss are also areas that will effect the safe operation of the vehicle. Persons with Alzheimer’s disease may not be able to process a lot of new information and may be overwhelmed by the distraction and volume of highway traffic. The person may be unable to remember specific navigational landmarks that once guided them around town safely. It is not unusual for experienced drivers with Alzheimer’s disease to become lost literally blocks away from their own home.

Your loved one may also be unable to distinguish and properly engage the necessary operational features of the vehicle such as emergency lights, night-lights, turn signals, etc. Weather conditions that warrant the balancing of inside air pressure such as defrosting or low/high speed wiper use may also pose visual problems for the person who is forgetful.

Another area of concern with person’s who are affected with Alzheimer’s disease and other memory impairments is their ability to appropriately respond to emergency situations when involved in accidents. These individuals may have no recollection of being involved in accidents and may even leave the scene as a result of their impairment

The third area of impairment that can have a major impact on your loved one’s ability to drive safely is their shortened attention span. Concentrating long periods of time especially when traveling long distances can be very challenging. Attention span lapses can place them and others in danger when one fails to remember or act upon the proper instructions of stop signs, merging or switching lanes or maneuvering through traffic lights.

The person’s ability to concentrate and follow highway instructions over an extended period of time becomes more difficult. Attention to critical details such as speed compliance, lane transfers and traveling through congested intersections are effected over time.

Another area that can effect the safe driving of a vehicle is that of slowed responses and reaction time. As Alzheimer’s disease progressives the person’s ability to respond quickly to various stimuli in the environment becomes diminished. Weather conditions and the need to adjust driving patterns such as breaking distances and driving speed can be effected by delayed response times.

The ability to interpret information is also affected with Alzheimer’s disease. As drivers we respond to a lot of external stimuli in the environment that is either recognized through our sight or through our hearing abilities. The aging process alone brings about changes in both our visual capabilities as well as hearing. More often then not these impairments can be adequately addressed through the use of glasses, surgical procedures or hearing aids. Due to the intellectual decline of a person with Alzheimer’s disease they are likely to have even more difficulty processing both visual and hearing stimuli.

Safety related sounds such as car horns, emergency sirens, or train whistles may go undetected placing the occupant and others at risk of an accident.

The person may also have difficulty overcoming and compensating for lost peripheral vision and depth perception. This can effect the safe driving distance one adheres to when following behind another vehicle. Another area that may become impaired is the person’s ability to proactively look ahead for possible signs of congestion or road hazards.

One of the difficult issues that caregivers attempt to balance in making a decision whether a person continues to drive or not, is the personal safety and independence of the person versus the general safety of the community. Another factor is the perceived role that the caregiver plays in making this decision. Experience has taught me that caregivers are unlikely to act quickly if they feel that their loved one will exhibit hostility and anger towards them. This "bad guy" role can often force a caregiver to deny or procrastinate in their decision to restrict privileges.

If your decision to restrict driving privileges is uncertain or difficult, caregivers may want to consider either contacting the Driver’s Licensing authority for your State or asking their family Physician to intervene. Most often physicians can play an instrumental role in taking away driving privileges while at the same time taking the blame for this tough decision. You may also want to solicit the support of other family members or close friends that could possibly influence the person to stop driving.

Remember, if all else fails when trying to stop your loved one from driving you may want to consider the following: