title: Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM).
abstract: OBJECTIVE
  To assess the influence of cognitive, functional and behavioral factors, co-morbidities as well as caregiver characteristics on driving cessation in dementia patients.
  
  
  METHODS
  The study cohort consists of those 240 dementia cases of the ongoing prospective registry on dementia in Austria (PRODEM) who were former or current car-drivers (mean age 74.2 (±8.8) years, 39.6% females, 80.8% Alzheimer's disease). Reasons for driving cessation were assessed with the patients' caregivers. Standardized questionnaires were used to evaluate patient- and caregiver characteristics. Cognitive functioning was determined by Mini-Mental State Examination (MMSE), the CERAD neuropsychological test battery and Clinical Dementia Rating (CDR), activities of daily living (ADL) by the Disability Assessment for Dementia, behavior by the Neuropsychiatric Inventory (NPI) and caregiver burden by the Zarit burden scale.
  
  
  RESULTS
  Among subjects who had ceased driving, 136 (93.8%) did so because of "Unacceptable risk" according to caregiver's judgment. Car accidents and revocation of the driving license were responsible in 8 (5.5%) and 1(0.7%) participant, respectively. Female gender (OR 5.057; 95%CI 1.803-14.180; p = 0.002), constructional abilities (OR 0.611; 95%CI 0.445-0.839; p = 0.002) and impairment in Activities of Daily Living (OR 0.941; 95%CI 0.911-0.973; p<0.001) were the only significant and independent associates of driving cessation. In multivariate analysis none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects including the MMSE and CDR were significantly associated with driving cessation.
  
  
  CONCLUSIONS
  The risk-estimate of caregivers, but not car accidents or revocation of the driving license determines if dementia patients cease driving. Female gender and increasing impairment in constructional abilities and ADL raise the probability for driving cessation. If any of these factors also relates to undesired traffic situations needs to be determined before recommendations for their inclusion into practice parameters for the assessment of driving abilities in the elderly can be derived from our data.
authors.affiliation: Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Seiler
authors.forename: Helena
authors.initials: H
authors.lastname: Schmidt
authors.forename: Anita
authors.initials: A
authors.lastname: Lechner
authors.forename: Thomas
authors.initials: T
authors.lastname: Benke
authors.forename: Guenter
authors.initials: G
authors.lastname: Sanin
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ransmayr
authors.forename: Riccarda
authors.initials: R
authors.lastname: Lehner
authors.forename: Peter
authors.initials: P
authors.lastname: Dal-Bianco
authors.forename: Peter
authors.initials: P
authors.lastname: Santer
authors.forename: Patricia
authors.initials: P
authors.lastname: Linortner
authors.forename: Christian
authors.initials: C
authors.lastname: Eggers
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haider
authors.forename: Margarete
authors.initials: M
authors.lastname: Uranues
authors.forename: Josef
authors.initials: J
authors.lastname: Marksteiner
authors.forename: Friedrich
authors.initials: F
authors.lastname: Leblhuber
authors.forename: Peter
authors.initials: P
authors.lastname: Kapeller
authors.forename: Christian
authors.initials: C
authors.lastname: Bancher
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D001317:Austria / Q000453:epidemiology; D001334:Automobile Driving / Q000706:statistics & numerical data*; D017028:Caregivers; D003071:Cognition; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs; D006801:Humans; D008004:Licensure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012042:Registries; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires