When to hang up the car keys on a person with dementia is a vexing problem. The Quality Standards subcommittee of the American Academy of Neurology has published updated practice parameters concerning the evaluation and management of driving risks in dementia. Using a systematic review of the literature with evidence-based methods, researchers from the Humboldt Neurological Medical Group in Eureka, California[1] reviewed the usefulness of patient demographic characteristics, driving history, and cognitive testing in predicting driving capability among patients with dementia. They also sought to determine the efficacy of risk reduction strategies in driving. They found the following characteristics useful for identifying patients at increased risk for unsafe driving: the Clinical Dementia Ratings Scale (Level A), a caregiver's rating of a patient's driving ability as unsafe (Level B), a history of crashes or traffic citations (Level C), reduced driving mileage or self-reported situational avoidance (Level C), mini-mental status score of 24 or less (Level C), and aggressive or impulsive personality characteristics (Level C). They found the following characteristics not useful for identifying patients at increased risk for unsafe driving: a patient's self-rating of safe driving ability (Level A) and a lack of situational avoidance (Level C). They found insufficient evidence concerning the benefits of neuropsychological testing or interventional strategies (Level U). This article was selected from Medscape Best Evidence.
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