WASHINGTON — Scientists are creating tests to show when it’s time for people with early Alzheimer’s disease to stop driving.
It’s one of a family’s most wrenching decisions, and as Alzheimer’s increasingly is diagnosed in its earliest stages, it can be hard to tell when a loved one is poised to become a danger.
Factor in that much of the country lacks public transportation, and quitting too soon restricts independence for someone who otherwise may function well for several years.
“That’s a real cost to the individual and family and society,” says Jeffrey Dawson of the University of Iowa. “You have to have some sort of trade-off between the individual’s independence along with the safety of the driver and with other people on the road.”
Typically, specialists say, patients gradually scale back their driving, avoiding busy freeways or night trips or left-turn intersections.
Dawson’s team in Iowa developed an intricate behind-the-wheel exam: a 35- mile drive through rural, residential and urban streets in a tricked-out car able to record just about every action the driver takes, much like an airplane “black box” does. Video cameras were positioned to show oncoming traffic, too.
Researchers recruited 40 people with early-stage Alz hei mer’s who still had their driver’s licenses to take the road test and compared how 115 older drivers without dementia handled the same trip.
The results, reported in the journal Neurology, are striking. On average, the Alzhei mer’s drivers committed 42 safety mistakes, compared with 33 for the other drivers.
Lane violations, such as swerving or hugging the center line as another car approaches, were the biggest problem for the Alzheimer’s drivers. They performed 50 percent worse.
Overall errors rose with increasing age whether or not the driver had Alzheimer’s, an extra 2 1/2 mistakes for every five years of age.
But some Alzheimer’s patients drove just as well as their healthier counterparts, stressed Dawson, a biostatistics professor.
Here’s the key: Researchers also checked whether any of a battery of neuropsychological tests given beforehand accurately predicted who would drive worse — and some did.
Flunking simple memory tests didn’t make a difference. Standard neurologic tests of multitasking abilities did, ones that assess whether people’s cognitive, visual and motor skills work together to make quick decisions. Examples include showing patients geometric figures for a few seconds and having them draw the shapes from memory, or drawing paths between a sequence of numbers and letters.
Alzheimer’s patients who scored average or better on those types of written tests were likewise no worse behind the wheel than other older drivers — but those who scored worse than average tended to commit about 50 percent more errors driving, Dawson said.
More research is needed, but the ultimate goal is an easy doctor’s-office exam to help guide when patients should give up the keys.
