title: Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transportation authorities in a region with mandatory reporting legislation.
abstract: OBJECTIVE
  To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to transportation authorities.
  
  
  METHODS
  We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family physicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anonymously online.
  
  
  RESULTS
  By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient's driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p <0.01). Based on these data, an algorithm was developed to guide physician decision-making about reporting patients with MCI or mild dementia to transportation authorities.
  
  
  CONCLUSIONS
  This study supports existing international guidelines that recommend specialized on-road testing when driving safety is uncertain for patients with MCI and emphasizes the importance of assessing executive dysfunction and caregiver concern about driving.
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: Mark.Rapoport@sunnybrook.ca.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rapoport
authors.affiliation: Institute of Health Policy Management & Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Rotman Research Scientist, Baycrest Geriatric Health Care Centre, University of Toronto, Toronto, Ontario, Canada; Research Department, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carla
authors.initials: C
authors.lastname: Zucchero Sarracini
authors.affiliation: Centre for Addiction and Mental Health, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.affiliation: Division of Geriatric Medicine, Providence Care, Queen's University, Kingston, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Frank
authors.affiliation: Institute of Health Policy Management & Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Division of Geriatric Psychiatry, Providence Care, Queen's University, Kingston, Ontario, Canada.
authors.forename: Dallas
authors.initials: D
authors.lastname: Seitz
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Vrkljan
authors.affiliation: Department of Neurology, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Masellis
authors.affiliation: Department of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Tang-Wai
authors.affiliation: Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pimlott
authors.affiliation: Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Molnar
mesh_terms: D000465:Algorithms; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D017028:Caregivers; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D032921:Consensus; D003657:Decision Making; D003697:Delphi Technique; D003704:Dementia / Q000175:diagnosis*; D006801:Humans; D019221:Mandatory Reporting; D009483:Neuropsychological Tests; D010820:Physicians / Q000331:legislation & jurisprudence; D014186:Transportation / Q000331:legislation & jurisprudence
keywords: Delphi technique; Dementia; automobile driving; consensus