title: Practice parameter update: evaluation and management of driving risk in dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology.
abstract: OBJECTIVE
  To review the evidence regarding the usefulness of patient demographic characteristics, driving history, and cognitive testing in predicting driving capability among patients with dementia and to determine the efficacy of driving risk reduction strategies.
  
  
  METHODS
  Systematic review of the literature using the American Academy of Neurology's evidence-based methods.
  
  
  CONCLUSIONS
  For patients with dementia, consider the following characteristics useful for identifying patients at increased risk for unsafe driving: the Clinical Dementia Rating scale (Level A), a caregiver's rating of a patient's driving ability as marginal or unsafe (Level B), a history of crashes or traffic citations (Level C), reduced driving mileage or self-reported situational avoidance (Level C), Mini-Mental State Examination scores of 24 or less (Level C), and aggressive or impulsive personality characteristics (Level C). Consider 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 lack of situational avoidance (Level C). There is insufficient evidence to support or refute the benefit of neuropsychological testing, after controlling for the presence and severity of dementia, or interventional strategies for drivers with dementia (Level U).
authors.affiliation: Humboldt Neurological Medical Group, Inc., Eureka, CA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Iverson
authors.forename: G S
authors.initials: GS
authors.lastname: Gronseth
authors.forename: M A
authors.initials: MA
authors.lastname: Reger
authors.forename: S
authors.initials: S
authors.lastname: Classen
authors.forename: R M
authors.initials: RM
authors.lastname: Dubinsky
authors.forename: M
authors.initials: M
authors.lastname: Rizzo
mesh_terms: D001333:Automobile Driver Examination / Q000331:legislation & jurisprudence / Q000523:psychology*; D001334:Automobile Driving / Q000523:psychology* / Q000592:standards*; D017028:Caregivers; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D004185:Disability Evaluation; D006801:Humans; D009483:Neuropsychological Tests / Q000592:standards; D010554:Personality Disorders / Q000175:diagnosis / Q000209:etiology; D011597:Psychomotor Performance / Q000502:physiology; D018570:Risk Assessment
references.citation: Ergonomics. 1995 May;38(5):1036-1048
references.pmid: 29105607
references.citation: J Am Board Fam Pract. 2002 Jan-Feb;15(1):11-9
references.pmid: 11841134
references.citation: Neurology. 2000 Jun 27;54(12):2205-11
references.pmid: 10881240
references.citation: J Am Geriatr Soc. 2000 Dec;48(12):1664-8
references.pmid: 11129759
references.citation: Neuropsychology. 2004 Jan;18(1):85-93
references.pmid: 14744191
references.citation: Alzheimer Dis Assoc Disord. 2001 Jan-Mar;15(1):10-20
references.pmid: 11236820
references.citation: Alzheimer Dis Assoc Disord. 1994 Winter;8(4):228-40
references.pmid: 7888153
references.citation: Neurology. 1993 Nov;43(11):2412-4
references.pmid: 8232972
references.citation: J Am Geriatr Soc. 2003 Oct;51(10):1342-7
references.pmid: 14511152
references.citation: JAMA. 1995 May 3;273(17):1360-5
references.pmid: 7715061
references.citation: Alzheimer Dis Assoc Disord. 1997 Jun;11 Suppl 1:13-6
references.pmid: 9194962
references.citation: Alzheimer Dis Assoc Disord. 2003 Apr-Jun;17(2):68-71
references.pmid: 12794382
references.citation: J Neurol Sci. 2006 Dec 21;251(1-2):35-43
references.pmid: 17049360
references.citation: J Am Geriatr Soc. 1995 Jul;43(7):776-81
references.pmid: 7602030
references.citation: JAMA. 2004 Jun 16;291(23):2840-6
references.pmid: 15199034
references.citation: J Am Geriatr Soc. 2001 Apr;49(4):466-9
references.pmid: 11347793
references.citation: CMAJ. 2006 Sep 12;175(6):591-5
references.pmid: 16966661
references.citation: Accid Anal Prev. 1998 May;30(3):305-12
references.pmid: 9663289
references.citation: Neurology. 2008 Apr 1;70(14):1171-8
references.pmid: 18216302
references.citation: Am J Epidemiol. 2000 Sep 1;152(5):424-31
references.pmid: 10981455
references.citation: Accid Anal Prev. 2002 Mar;34(2):257-61
references.pmid: 11829296
references.citation: Traffic Inj Prev. 2004 Jun;5(2):112-6
references.pmid: 15203945
references.citation: J Int Neuropsychol Soc. 2005 Oct;11(6):766-75
references.pmid: 16248912
references.citation: J Neurol Neurosurg Psychiatry. 2005 Jun;76(6):764-8
references.pmid: 15897495
references.citation: Neurology. 2009 Feb 10;72(6):521-7
references.pmid: 19204261
references.citation: J Am Geriatr Soc. 2005 May;53(5):829-33
references.pmid: 15877559
references.citation: Brain Inj. 2005 Mar;19(3):177-88
references.pmid: 15832892
references.citation: Neurology. 2004 Sep 14;63(5):832-7
references.pmid: 15365132
references.citation: Accid Anal Prev. 2006 Sep;38(5):1038-45
references.pmid: 16725099
references.citation: JAMA. 1998 Apr 8;279(14):1083-8
references.pmid: 9546567
references.citation: J Am Geriatr Soc. 1993 Jul;41(7):747-52
references.pmid: 8315186
references.citation: Arch Neurol. 1997 May;54(5):545-51
references.pmid: 9152111
references.citation: J Am Geriatr Soc. 1997 Aug;45(8):949-53
references.pmid: 9256847
references.citation: Clin Neuropsychol. 2001 Aug;15(3):329-36
references.pmid: 11778771
references.citation: J Gerontol. 1994 Jul;49(4):M153-9
references.pmid: 8014389
references.citation: Alzheimer Dis Assoc Disord. 2003 Jan-Mar;17(1):27-34
references.pmid: 12621317
references.citation: J Am Geriatr Soc. 2005 Jan;53(1):94-8
references.pmid: 15667383