What is the relationship between memory loss and driving?

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Age-related cognitive changes can impact driving safety.

You have just seen your doctor and you have been diagnosed with mild cognitive impairment or Alzheimer’s disease. Does that mean you shouldn’t drive?

Driving requires many brain systems to work together

Driving is a complicated skill and a dangerous activity. Nearly 43,000 people dead in road accidents in the United States in 2021.

In addition to good physical health, driving requires many brain systems to work together. The thinking part of your brain is made up of four pairs of lobes – occipital, temporal, parietal and frontal – in the left and right hemispheres of the brain, and all of them are active when you drive:

  • The visual object system in your occipital and temporal lobes processes images coming from your eyes to help you distinguish between cars, bicycles and pedestrians.
  • The visuospatial system of your occipital and parietal lobes determines where cars, bikes, and pedestrians are on the road, how fast they are moving, and anticipates where they will be in seconds.
  • The attention system in your parietal lobes and the auditory system in your superior temporal lobe allow you to stay alert to car horns and other signs of danger.
  • The decision-making system in your frontal lobes uses this visual, auditory, spatial, and motion information to determine how fast you should go and if you should turn.
  • The motor system in your frontal lobes then translates these decisions into how hard your foot presses the pedals and whether your hands turn the steering wheel.

Driving combines conscious and unconscious brain activity

“Wow”, you might be thinking, “how can I do all these activities while I’m driving while singing along to the radio, listening to an audiobook or talking with my friend sitting in the passenger seat?” The answer is that once you learn to drive, most of your routine driving happens automatically and unconsciously. In fact, it’s becoming increasingly clear that you perform most of your daily routines automatically, without conscious effort control your actions. That’s why, if you get distracted while driving, you may find yourself driving to work on autopilot when you wanted to get groceries.

Your conscious mind takes control, however, whenever the situation calls for it. So if you are driving in a snowstorm, when it is raining, or on an icy road, your conscious mind will devote its attention to your driving. That’s why you’ll stop singing, pause the audiobook, and ask your friend to hold on for a minute in these situations.

Alzheimer’s disease and other dementias impair driving

Alzheimer’s disease and other forms of dementia affect a variety of different brain regions, including the four lobes of the brain. For this reason, people with Alzheimer’s disease often exhibit impaired visual, auditory, attention, and decision-making abilities. However, not everyone with Alzheimer’s disease needs to stop driving. It depends on both the overall severity of the disease and the specific cognitive abilities that are impaired.

Alzheimer’s disease begins silently, with a buildup of plaques and tangles in the brain but no symptoms. When the disease begins to affect thinking and memory but function is normal, it has reached the mild cognitive impairment arrange. When the function is impaired, it has reached the dementia arrange. When only one or two complicated activities are impaired (like paying bills), Alzheimer’s disease is in the very mild dementia stage.

A study revealed that people with Alzheimer’s had an average of 0.09 car accidents per year, compared to 0.04 accidents in healthy adults of the same age. Another study found that people with Alzheimer’s disease in the mild cognitive impairment and very mild dementia stages had impairments similar to those of drivers aged 16 to 20. So, on the one hand, people with Alzheimer’s disease are at an increased risk of driving. On the other hand, when Alzheimer’s disease is very mild, accident rates are similar to those of new drivers – a group that we, as a society, allow to drive with little or no restrictions.

Should people with Alzheimer’s disease drive?

The American Academy of Neurology published guidelines to help clinicians know when people with Alzheimer’s disease and other dementias should stop driving. These guidelines were then validated by a survey of caregivers. The guidelines suggest that clinicians consider the following factors, as accident risk increases when more than one of these factors are present:

  • Do caregivers report marginal or unsafe driving skills?
  • Is there a citation history?
  • Is there a history of accidents?
  • Do they drive less than 60 miles per week?
  • Do they avoid driving in certain situations?
  • Do they show aggression or impulsiveness in their conduct?
  • Is their cognition impaired on standard tests?
  • Is there evidence of other factors that may impair their driving, such as alcohol use, medications that cause cognitive impairment, sleep disturbance, visual impairment, or motor impairment?

My advice

If you’ve been diagnosed with a memory impairment, ask a family member (or close friend) to ride in the car with you each month. One of your adult children would be the best. If your children feel comfortable with your driving, it usually means that you are driving safely.

Note that I am not concerned if you make a wrong turn or get lost. If you get lost, you can use a GPS or phone app, or ask someone for directions. I’m only concerned that you’re a safe driver and don’t endanger yourself or others on the road.

What if your family thinks your driving is unsafe, but you think you’re a good driver? Pass a driving test at the local motor vehicle registry office or at a rehabilitation hospital. This will allow you to prove to your family that you are a safe driver. If you don’t pass the test, be brave enough to hang up your keys. Take a cab, use a ridesharing appor – better yet – ride with a friend.

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