Should Someone With Dementia Drive?
By Carole Larkin
FINALLY, there are tests to help doctors determine whether a person with dementia can continue to drive.
Well, they are really screening tests to predict whether a person with dementia will fail a road driving test. I found an article about the screening tests in the September/October edition of the magazine Today’s Geriatric Medicine pages 13-15. (www.todaysgeriatricmedicine.com). They are meant for a doctor or his trained assistant to administer in the office when a family member or another person expresses concern about the person with dementia’s driving ability. It appears to me that it will take about a half hour to administer, grade and interpret the outcome of the tests. If the person “fails” or in my opinion, has less than a 50% score, (meaning that they have less than a 50-50 chance of passing a real driving test), then that indicates that they should have a thorough driving test given by specialized occupational therapists. That 50% cut off is just my opinion, you might think that under a 70% (or other percentage) score means that they need further evaluation. That’s up to you.
Where do you find these specialized occupational therapists? Usually in fairly large cities with large hospitals (teaching hospitals or regular hospitals). You’d probably have to call the hospitals to see if they have one in their occupational therapy department. You probably would have to talk to the occupational therapy department itself; I doubt anyone else in the hospital would even know about the specialized occupational therapists.
With this specialized evaluation, if the person with dementia fails those tests, you have proof in writing that they can no longer drive. It’s very hard for the person with dementia to argue that they can still drive when you show them in writing the proof that they can’t. If it was me, I’d make a number of copies of the findings, in case the person gets mad and rips them up every time they see them. (I believe in being prepared for the worst.) You might also send a copy of the tests to your state’s driving licensing authority, the insurance company that insures their car/truck, and the local police, just to be sure everybody involved in taking away the keys knows that the person can no longer drive.
Do I believe that primary care doctors have time to administer these tests on a regular basis? Heck no! Nowadays office visits average 7-10 minutes. Maybe some doctors will appoint someone in their office to train to administer the tests, and have them do it. That is, if they even have extra staff available to do it, along with their regular jobs. When have you seen extra staff at your doctor’s office? Aha- that’s what I thought. Instead the doctor could set aside a day a week/month when there somebody at the office to administer the tests, like maybe on a Saturday? We can hope!
I am attaching the links to the two tests used in this screening and how to score them, so you can print them out and take them to your doctor. The first test is the MMSE the most common screening test used by doctors to discover cognitive deficits. (I think there are far better tests for cognitive deficits than the MMSE. The MOCA is one of my favorites. But hey, this is not about me!) The researchers used this test in developing their tool (the Fit2Drive app) to help decide whether to refer the patient for more thorough testing, so I’m including its link here.
The second test is the Trail-Making Test Part B. There is a Trail-Making Test Part A that is used to get the person being tested a little practice in doing that type of test before actually attempting the real test, Part B. I’ve included the Link to both Part A and Part B and how to score them.
After the two tests are taken and scored, the person testing takes the total score, adding the Score on the MMSE and the Trails B time it took to complete it correctly and enters them into the slots for each on the calculator at the website, http://Fit2Drive.us or by downloading its Mobil app to your cellphone, (both Apple and Android are available) from that same website. The answer will indicate the probability that the person could pass the road part of the driving test given by the special occupational therapists.
Remember, these two tests and the Fit2Drive tool are made for doctors or their trained assistants to administer, not the general public. If you wish to administer the tests and use the tool yourself, you are doing so at your own risk. You would have to read the instructions to train yourself how to do it 100% correctly, and most importantly, when you grade it you must do so with absolute impartiality, no matter how much you want the person to fail. After all, how embarrassed would you be if you say the person failed and they didn’t, and they insisted on taking the more complete tests given by the occupational therapists and they passed them? Yikes! I’m just warning you up front, because there is NO WAY that I’m taking the fall for what happens out of the testing when you do it. It’s truly on you.
Of course, these screening tests can always be repeated after time passes to see if the person’s abilities have deteriorated more.
Hopefully this will help get some dangerous drivers off the road, and lower your stress level about your loved one driving with dementia.
Carole Larkin can be reached via Email.
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