Deciding when to take the car keys away from someone with dementia is one of the most heart wrenching tasks that caregivers face. The milestone is a huge blow to the driver, who loses his/her independence, and to the caregiver, who is forced to take on even more responsibility. My husband never forgave me for taking away his car. He reminded me on a weekly basis that he was angry with me.

But according to a study at Florida Atlantic University, Boca Raton, FL, drivers diagnosed with early Alzheimer’s disease may be able to maintain their road skills over the course of a year if they are treated with Memantine.*  The study included 60 otherwise healthy men and women over 60 years of age, who had mild Alzheimer’s disease — defined as a Mini Mental State Examination score of at least 23. Twenty-nine participants completed six months of the program, and 25 completed the 12-month study.

Peter Holland, MD, lead author of the study, said that despite the small group of participants in the study his research team was able to show a statistically significant difference between the drivers who were on memantine and those who were on placebo. In an article written by Ed Susman for MedPage Today, Holland is quoted as saying, “We believe that adding Memantine to the drug regime is effective in delaying driving impairment in subjects with mild Alzheimer’s disease.”

An earlier study done at the University of Michigan in Ann Arbor assessed the driving skills of 17 people with a diagnosis of early stage dementia. Their cars were equipped with special instruments for the two-month study in order to analyze a set of driving behaviors that might be common among drivers with dementia. The memory-impaired individuals were able to drive as safely as the comparison group, but they were more likely to get lost.

Although some people with early stage Alzheimer’s disease are able to drive for a year or two after diagnosis, it’s imperative that caregivers continually assess their skills in order to ensure safety for the driver, passenger(s) and other drivers. If a person with Alzheimer’s disease is in a tragic automobile accident, the consequences can be emotionally, physically and financially catastrophic for the families involved.

When you are concerned about the safety of a memory-impaired driver

Dr. Jason Karlawish, associate director of the Memory Disorders Clinic and fellow of the Center for Bioethics at the University of Pennsylvania, said it helps to give dementia patients’ families some perspective.

“In my practice, I recommend that family members and friends ask themselves a simple question,” he said. “‘Would you let your relative with Alzheimer’s disease drive the grandchildren, or someone else’s grandchildren, to an event?’ If they answer to this is anything less than a simple ‘Yes,’ then it is sensible to consider at least a driving evaluation or even taking away the keys.”

 For caregivers, the question of when to take away the car keys is always a difficult one. Here are some resources that can help.

• Make an appointment with your doctor and let him or her make the decision. Often the memory-impaired individual will listen more readily to a doctor than to a family member or friend.
• Contact the Alzheimer’s Association® for help. 24/7 Helpline: 1-800-272-3900 or visit their site that specifically discusses Driving assessment.
• The University of Michigan Transportation Research Institute and the UM Drive-Ability Program has published an excellent on-line driver evaluation test at: um-saferdriving.org. This is an excellent assessment of driving ability for seniors and those with early stage Alzheimer’s disease. The test can be completely in less than 30 minutes, with or without the help of a caregiver. Based on the answers, a report is instantly issued with health concerns the driver might be experiencing, i.e. reduced visual acuity, and a list of driving skills that might be affected by the health concerns, i.e. turning, yielding, etc. A list of recommendations for safer driving is given, along with a list of ways to modify the driver’s vehicle and other safety tips.
• When Your Are Concerned: A Handbook for Families, Friends, and Caregivers Worried About the Safety of an Aging Driver (and Help Network) is an 8 chapter handbook available online. aging.state.ny.us/caring/concerned
• How to Help an Older Driver is a 30-page booklet that provides readers with details of how age and medications affect a person’s driving skills, how to assess an older driver’s skills both through self-screening and by observing various factors, how to help an older driver by ensuring he or she exercises and sees a physician regularly, and what features to look for in choosing a car. It also provides a list of driver refresher courses and offers suggestions for how to help older drivers cope and plan for driving cessation, and how to overcome the fear of losing independence. Finally, it provides contact information for every state department of motor vehicles and lists of useful websites for aging drivers. Funded by AAA Foundation for Traffic Safety. aaafoundation.org

* Memantine is the first in a novel class of Alzheimer’s disease medications acting on the glutamatergic system by blocking NMDA-type glutamate receptors. It was first synthesized by Eli Lilly and Company in 1968. Memantine is marketed under the brands Axura and Akatinol by Merz, Namenda by Forest, Ebixa and Abixa by Lundbeck and Memox by Unipharm. Memantine has been shown to have a modest effect in moderate-to-severe Alzheimer’s disease and in dementia with Lewy bodies. Despite years of research, there is little evidence of effect in mild Alzheimer’s disease. (wikipedia)

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If you would like to read about tools and techniques that can help you stay strong as a caregiver, reduce stress and support your immunity, read Calmer Waters: The Caregiver’s Journey Through Alzheimer’s and Dementia