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Driving is a complex activity that demands quick reactions, alert senses and split-second decisions. For the person with Alzheimer’s, driving inevitably becomes difficult. Giving up driving can be even more difficult.

In our culture, driving is synonymous with adulthood and independence. "It’s devastating to be told you are no longer capable of driving," say Jonathan Trobe, MD, a neurologist and researcher at University of Michigan’s Transportation Research Institute. "That’s why many individuals with Alzheimer’s, particularly men, are reluctant to leave the driving to someone else."

There are conflicting opinions about whether someone with Alzheimer’s should drive. People with early stage Alzheimer's look and behave normally a good deal of the time. However, their brains have already been damaged, a fact manifested by shortened attention spans and diminished planning, calculation and visuospatial skills. They may have good visual acuity but poor response to visual form. In other words, they can see the letters or symbols on a sign very clearly, but they may not be able to interpret them. They may appear to be physically fit to drive, i.e., have good joint mobility, coordination, depth perception and other important skills. But while driving, they may stop in traffic, drift into other lanes of traffic, make sudden turns or miss exits, react slowly to obstacles in their path, be confused or easily distracted by construction or other changes on a familiar route, or fail to appreciate why other drivers signal them in frustration or exasperation.

But a diagnosis of Alzheimer’s does not mean the person has lost all abilities. "Drivers rely on visual and spatial sensitivity, which is not immediately impaired in all persons with Alzheimer’s," says Trobe. "A diagnosis of Alzheimer’s doesn’t mean a person should be automatically stripped of their license."

How long can someone with Alzheimer’s continue to drive safely, and how do caregivers know when to discourage driving? Caregivers should watch their loved one for the following "warning signs" of unsafe driving:

• Is unable to locate familiar places;
• Does not observe traffic signs or drives at an inappropriate speed;
• Makes poor of slow decisions in traffic; and
• Becomes angry, frustrated or confused while driving.

(Also, see "Warning signs for drivers with dementia.")

The following strategies can help ease a person’s transition from driver to passenger:

Acknowledge the loss. "Giving up the keys represents a loss of independence and mobility, traits that individuals with dementia are striving to maintain," says Trobe. Caregivers should be especially sensitive and supportive during this awkward period. The former driver may be depressed and angry. Be reassuring and try to involve the person in other aspects of travel. Put them in charge of the radio and temperature controls and ask them to watch for important signs.

Arrange for transportation. People, including individuals with dementia, often drive out of necessity. Reassure the person with Alzheimer’s disease that a ride will be available whenever they need to go somewhere. Plan ahead so that rides can be arranged early and drivers secured. And make certain that the person doing the transporting is the one who actually drives, not the person with Alzheimer’s disease.

Solicit the support of others. Most people will listen to their doctor. Ask your physician to advise the person with Alzheimer’s not to drive. "My mother’s doctor actually wrote a prescription that said, "no driving," says caregiver Jane Wachter. "She respects the ‘doctor’s orders’ and no longer argues with me over the keys." Relatives, a trusted friend or even an insurance agent can reinforce the message that driving can be dangerous.

Make the car less accessible. Keep the care keys with you at all times, and leave your "extra set" with a neighbor. If the car is not often used, disable it (by removing the distributor cap) or park it down the street where the person with Alzheimer’s disease won’t see it. If the car is not needed, sell it. The money saved in insurance premiums, gas and maintenance could cover the costs of special transportation arrangements and taxicab rides.

Take the test. You may need to go directly to your state department of motor vehicles for help. Explain to them your concerns and ask them to retest the driver. It is often difficult for a person with dementia to pass the required tests. As a last resort, in most states you can even request that the person’s license be revoked. The state may require a letter from a physician that certifies that taking away a license will necessarily discourage driving. You’ll still have to make certain the person with Alzheimer’s disease doesn’t have access to the car.

Be firm. Avoid arguments, and long explanations for why driving is no longer an option. Focus on other activities that the person can still enjoy. Formulate a driving plan early on and ask for assistance from family and friends.

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