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Predictors of driving cessation in mild-to-moderate dementia

From Sunnybrook Health Sciences Centre and the Department of Psychiatry, University of Toronto (Herrmann, Rapoport), Toronto, Ont.; Syreon Corporation (Sambrook), Vancouver, BC; Sherbrooke University (Hébert), Sherbrooke, and the University of Montreal (Robillard), Montréal, Que.; and Glenrose Rehabilitation Hospital (McCracken), Edmonton, Alta.

Correspondence to: Dr. Nathan Herrmann, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto ON M4N 3M5; tel 416 480-6133; fax 416 480-6022; n.herrmann{at}utoronto.ca

Background: Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementia-related factors associated with driving cessation. The purpose of our study was to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia.

Methods: A 3-year prospective study, the Canadian Outcomes Study in Dementia (COSID) has enrolled 883 patients with mild-to-moderate dementia at 32 centres across Canada. Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for staging (severity), the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behaviour. Factors associated with the decision to quit driving after the baseline assessment were tested with Cox survival analysis.

Results: Of 719 subjects who were or had been drivers, 203 (28.2%) were still driving at baseline. Over an observation period that averaged 23 months, 97 (48.5%) of 200 patients quit driving. Factors predictive of driving cessation included GDS (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.15–2.45), MMSE score (HR 0.90, 95% CI 0.83–0.97) and NPI findings (HR 1.63 for presence of 3 behaviours, 95% CI 1.01–2.62). Among the NPI behaviours, when they were analyzed separately, agitation led to a decreased likelihood of driving cessation (p = 0.019), whereas apathy (p = 0.031) and hallucinations (p = 0.050) led to an increased likelihood.

Interpretation: Cognitive impairment and behaviours such as agitation, apathy and hallucinations were significant predictors of driving cessation in patients with a mild to moderate degree of dementia. These findings should be considered when one counsels patients and their families.

This article has been cited by other articles:

				D. O'Neill Driving and dementia Can. Med. Assoc. J., January 30, 2007; 176(3): 351 - 351. [Full Text] [PDF]

				D. B. Carr, T. M. Meuser, and J. C. Morris Driving retirement: the role of the physician. Can. Med. Assoc. J., September 12, 2006; 175(6): 601 - 601. [Full Text] [PDF]

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