When is it time to take the keys away?

Up to 76 percent of people with mild dementia are still able to pass a driving test. Does that mean they should be behind the wheel of a car?

PLEASE: Take the poll at the bottom of this post.

The American Academy of Neurology issued new guidelines recently to help neurologists and other doctors determine when to take the car keys away. The group's work was based on a study of articles on dementia, driving and aging from 1970 to 2006.

Here's what they say is useful:
* the "clinical dementia rating scale"
* caregiver’s rating of a patient’s driving ability as marginal or unsafe
* a history of crashes or traffic citations
* reduced driving mileage or self-reported situational avoidance
* mini-mental state examination scores of 24 or less
* aggressive or impulsive personality characteristics

Here's what they say is not:
* a patient’s self-rating of safe driving ability
* a lack of situational avoidance

The new guidelines don't have universal support.

“We don’t have a blood-alcohol level for dementia,” Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York, told the New York Times. But he pointed out that dementia accelerates the risks older drivers face from declining vision, hearing and reaction time. He told the newspaper that the American Association for Geriatric Psychiatry, of which he is a past president, uses a stricter standard: “Our recommendation is that you stop driving once you have a dementia diagnosis.”

Giving up driving has a significant impact on the life of a person with dementia--no matter when that happens.

"We sometimes gloss over how devastating taking away the keys can be," says the GeriPal blog, (a geriatrics and palliative care forum with multiple contributors.) "There is a tendency to suggest patients find alternative means of transportation, even though we are fully aware that for many patients, there is no alternative. Loss of driving privileges will often lead to isolation, an impaired quality of life, and depression.

"Our aging unfriendly world is often not kind to people who can no longer drive. We provide them no alternative transportation options, and offer little in the way of supportive services that will help them stay socially engaged after they stop driving."

From the American Academy of Neurology: Evaluation and management of driving risk in dementia

The news release summarizing the new guidelines

The story in Business Week

Driving with early Alzheimer's even riskier than first believed, from the archives of DementiAwareness