Category Archives: dementia travel

Is it time to take away the car keys?

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Senior woman driving a car in traffic jamDeciding 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

BarbraCohn__

Why you should see a doctor if you’re worried about your memory

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I’ve done it. You’ve probably done it, too.  Forgetting where you parked your car is not uncommon. Once I parked in a four level garage at a mall and walked up and down the stairwell with my then-teenaged daughter, who couldn’t find the car either. I ended up calling security and had the guard drive me through the parking garage until I found the car. That was a bit embarrassing. But forgetting where you parked or the name of a familiar face are common age-related memory lapses. I’ve always been lousy at remembering names of people I know, characters from novels, and the names of movies and actors. That doesn’t mean I’m losing it. My explanation, although it might not be scientific, is that I have so many facts and information stored in my brain that my memory is discretionary.

But if you have difficulty recognizing a relative, find your missing keys in the refrigerator, or get lost driving in the town you’ve lived in for years, you should make an appointment with your health care provider. Because if you do have cognitive impairment, the sooner you get help the better.

One of the first signs that my husband (who died from early-onset Alzheimer’s disease) was having memory lapses was that he started getting lost while driving the car in our home town. That scared him, and it scared me. I finally got him to agree to see a doctor, two years after I suspected that something was wrong.

There are lots of reasons to see a doctor if you or your loved one suspects that you are having cognitive difficulties.

  • Individuals who start to forget things or get confused can become depressed, anxious, angry, and/or frustrated because they don’t understand why their thoughts aren’t clear or why they are having difficulty performing certain tasks that were always easy. My philosophy is that knowledge is power. It’s better to know what is happening than to be left in the dark. A consultation with a health professional can help explain what is going on.
  • According to researchers at the University of Michigan, more than half of older adults with signs of memory loss never see a doctor about it. Although there is still no certain way to prevent or forestall most cognitive diseases, knowing that someone has serious memory problems can alert family members and friends to a need for changes in the person’s living arrangements that can be health-or even life-saving. Early evaluation and identification of people with dementia may help them receive care earlier,” says study author Vikas Kotagal, M.D., M.S. “It can help families make plans for care, help with day-to-day tasks including observed medication administration, and watch for future problems that can occur. In some instances, these interventions could substantially improve the person’s quality of life.”
  • If driving becomes difficult it’s important to get an evaluation from your local Driver Motor Vehicle department because of liability and safety issues. This is a very touchy subject and was one of the most difficult thresholds for my husband and me to cross through. He continually blamed me for being the ogre who took away his car keys. But it’s important to know that if a caregiver, spouse or other significant family member knows that a loved one has a diagnosis of Alzheimer’s or other dementia, that family member could be held responsible in case of an accident. If, god-forbid, someone is killed, the repercussions could be emotionally, physically and financially disastrous.

What Should You Do?

  1. Make an appointment with your general physician and express your concerns. Your doctor will ask you some questions such as: how are you sleeping at night? How often do you drink alcohol? Are you sedentary? Do you exercise? Are you depressed? What is your typical diet? Your doctor might do a blood panel to determine if you have any organic markers such as low thyroid or anemia that could affect your energy and memory.
    2. Your doctor might give you a brief memory assessment or refer you to a memory clinic for further evaluation. The MMSE (Mini-Mental State Exam,http://www.mountsinai.on.ca/care/psych/on-call-resources/on-call-resourc…) is an eight-minute test that has been used since 1975. According to neurologists, the 10-12 minute MoCA (Montreal Cognitive Assessment,http://www.mocatest.org/about/), used since 1996, is more discerning.

Don’t delay. Make an appointment if you or your loved one has memory concerns.

10 Signs of Alzheimer’s Disease
1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

Reference
Kotagal V, Langa KM, Plassman BL, Fisher GG, Giordani BJ, Wallace RB, Burke JR, Steffens DC, Kabeto M, Albin RL, Foster NL. Factors associated with cognitive evaluations in the United States. Neurology. 2015 Jan 6;84(1):64-71.