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Alzheimer's Disease Causes, Stages, and Symptoms (cont.)

Medical Author:
Howard Crystal, MD
Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:
Jay W. Marks, MD
Jay W. Marks, MD
Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Driving

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Driving is a complex activity that demands quick reactions, alert senses, and split-second decision making. For a person with Alzheimer's disease, driving becomes increasingly difficult. Memory loss, impaired judgment, disorientation, impaired visual and spatial perception, slow reaction time, certain medications, diminished attention span, and inability to recognize cues such as stop signs and traffic lights can make driving particularly hazardous.

People with Alzheimer's who continue to drive can be a danger to themselves, their passengers, and the community at large. As the disease progresses, they lose driving skills and must stop driving. Unfortunately, people with Alzheimer's often cannot recognize when they should no longer drive. This is a tremendous safety concern. It is extremely important to have the impaired person's driving abilities carefully evaluated.

Warning Signs of Unsafe Driving

Often, the caregiver or a family member, neighbor, or friend is the first to become aware of the safety hazards of someone with Alzheimer's behind the wheel. If a person with Alzheimer's disease experiences one of more of the following problems, it may be time to limit or stop driving.

Does the person with Alzheimer's:

  • get lost while driving in a familiar location?

  • fail to observe traffic signals?

  • drive at an inappropriate speed?

  • become angry, frustrated, or confused while driving?

  • make slow or poor decisions?

Please do not wait for an accident to happen. Take action immediately!

Explaining to the person with Alzheimer's disease that he or she can no longer drive can be extremely difficult. Loss of driving privileges may represent a tremendous loss of independence, freedom, and identity. It is a significant concern for the person with Alzheimer's and the caregiver. The issue of not driving may produce anger, denial, and grief in the person with Alzheimer's, as well as guilt and anxiety in the caregiver. Family and concerned professionals need to be both sensitive and firm. Above all, they should be persistent and consistent.

The doctor of a person with Alzheimer's disease can assist the family with the task of restricting driving. Talk with the doctor about your concerns. Most people will listen to their doctor. Ask the doctor to advise the person with Alzheimer's to reduce his or her driving, go for a driving evaluation or test, or stop driving altogether. An increasing number of States have laws requiring physicians to report Alzheimer's and related disorders to the Department of Motor Vehicles. The Department of Motor Vehicles then is responsible for retesting the at-risk driver. Testing should occur regularly, at least yearly.

When dementia impairs driving and the person with Alzheimer's disease continues to insist on driving, a number of different approaches may be necessary.

  • Work as a team with family, friends, and professionals, and use a single, simple explanation for the loss of driving ability such as: "You have a memory problem, and it is no longer safe to drive," "You cannot drive because you are on medication," or "The doctor has prescribed that you no longer drive."

  • Ask the doctor to write on a prescription pad DO NOT DRIVE. Ask the doctor to write to the Department of Motor Vehicles or Department of Public Safety saying this person should no longer drive. Show the letter to the person with Alzheimer's disease as evidence.

  • Offer to drive or ask a friend or family member to drive.

  • Walk when possible, and make these outings special events.

  • Use public transportation or any special transportation provided by community organizations. Ask about senior discounts or transportation coupons. The person with Alzheimer's should not take public transportation unsupervised.

  • Park the car at a friend's home.

  • Hide the car keys.

  • Exchange car keys with a set of unusable keys. Some people with Alzheimer's are in the habit of carrying keys.

  • Place a large note under the car hood requesting that any mechanic call you before doing work requested by the person with Alzheimer's disease.

  • Have a mechanic install a "kill switch" or alarm system that disengages the fuel line to prevent the car from starting.

  • Consider selling the car and putting aside for taxi fares the money saved from insurance, repairs, and gasoline.

  • Do not leave a person with Alzheimer's alone in a parked car.

Patient Comments

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Alzheimer's Disease - Dementia Question: Has a friend or relative been diagnosed with dementia? What are her/his symptoms?
Alzheimer's Disease - Warning Signs Question: Do you have any of the warning signs of Alzheimer's? Please discuss your symptoms and concerns.
Alzheimer's Disease - Home Safety Question: In what ways have you made the home safer for a friend or relative with Alzheimer's disease?
Alzheimer's Disease - Medications Question: If your relative is on a medication for Alzheimer's, what changes have you noticed?
Alzheimer's Disease - Driving Question: What motivated you to take away the keys or car from your loved one who has Alzheimer's?
Alzheimer's Disease - Prognosis Question: What is the prognosis for your friend or relative who has Alzheimer's disease?
Alzheimer's Disease - Describe Your Experience Question: Please describe the symptoms you or loved one experienced with Alzheimer's disease.
Alzheimer's Disease - Treatments Question: What stage of Alzheimer's disease are you or your loved one currently experiencing, and have any treatments been effective?
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