Dementia and Driving: When Should Dementia and Driving: When Should You Put on the Brakes?You Put on the Brakes?

Driving and Alzheimer's Driving and Alzheimer's disease disease

The risk of crashes The risk of crashes

David A. Drachman, MD, Joan David A. Drachman, MD, Joan M. Swearer, PhD andM. Swearer, PhD and

Collaborative Study GroupCollaborative Study Group

We conclude that (1) the existing evidence suggests that We conclude that (1) the existing evidence suggests that AD AD patientspatients who drive present a who drive present a slightly increased risk for slightly increased risk for

crashes compared with drivers of all agescrashes compared with drivers of all ages but a but a lower risk lower risk than young unimpaired driversthan young unimpaired drivers, especially males. (2) During , especially males. (2) During the the first 2 to 3 years after the onset of AD, the magnitude of first 2 to 3 years after the onset of AD, the magnitude of

risk of crashes is well within the accepted risk for other risk of crashes is well within the accepted risk for other registered driversregistered drivers. (3) There is marked . (3) There is marked variabilityvariability in the in the

degree of disabilitydegree of disability due to ADdue to AD and its rate of progression. and its rate of progression. Because of this, Because of this, direct tests of driving competence—ratherdirect tests of driving competence—rather than the than the diagnosis of AD per se—should be considered as diagnosis of AD per se—should be considered as

the criterionthe criterion for continued licensure to drive, with sufficiently for continued licensure to drive, with sufficiently frequent retestingfrequent retesting to anticipate the expected decline over to anticipate the expected decline over

years. years.

NEUROLOGY 1993;43:2448NEUROLOGY 1993;43:2448

Driver route-following and safety errors in early Alzheimer disease.Driver route-following and safety errors in early Alzheimer disease.Uc EY, Rizzo M, Anderson SW, Shi Q, Dawson JD.Uc EY, Rizzo M, Anderson SW, Shi Q, Dawson JD.

Division of Neuroergonomics, Department of Neurology,Division of Neuroergonomics, Department of Neurology, College of Medicine, University of Iowa, Iowa City, IA, USA.College of Medicine, University of Iowa, Iowa City, IA, USA.

20042004

Driver route-following and safety errors in early Driver route-following and safety errors in early Alzheimer disease.Alzheimer disease.

Uc EY, Rizzo M, Anderson SW, Shi Q, Dawson JD.Uc EY, Rizzo M, Anderson SW, Shi Q, Dawson JD.Division of Neuroergonomics, Department of Neurology, College of Medicine, University of Iowa, Division of Neuroergonomics, Department of Neurology, College of Medicine, University of Iowa,

Iowa City, IA, USA.Iowa City, IA, USA.

OBJECTIVE: To assess navigation and safety errors during a route-following task OBJECTIVE: To assess navigation and safety errors during a route-following task in drivers with Alzheimer disease (AD). DESIGN/METHODS: Thirty-two subjects in drivers with Alzheimer disease (AD). DESIGN/METHODS: Thirty-two subjects with probable AD (by National Institute of Neurological and Communicative with probable AD (by National Institute of Neurological and Communicative Disorders criteria) of Disorders criteria) of mild severitymild severity and 136 neurologically normal older adults and 136 neurologically normal older adults were tested on a battery of visual and cognitive tests of abilities that are critical were tested on a battery of visual and cognitive tests of abilities that are critical to safe automobile driving. Each driver also performed a route-finding task to safe automobile driving. Each driver also performed a route-finding task administered on the road in an instrumented vehicle. Main outcome variables administered on the road in an instrumented vehicle. Main outcome variables were number of 1) incorrect turns; 2) times lost; and 3) at-fault safety errors. were number of 1) incorrect turns; 2) times lost; and 3) at-fault safety errors. RESULTS: The drivers with mild AD made significantly more incorrect turns, got RESULTS: The drivers with mild AD made significantly more incorrect turns, got lost more often, and made more at-fault safety errors than control subjects, lost more often, and made more at-fault safety errors than control subjects, although their basic vehicular control abilities were normal. The navigational and although their basic vehicular control abilities were normal. The navigational and safety errors were predicted using scores on standardized tests sensitive to safety errors were predicted using scores on standardized tests sensitive to visual and cognitive decline in early AD. visual and cognitive decline in early AD.

CONCLUSIONS: CONCLUSIONS: Drivers with Alzheimer disease made more Drivers with Alzheimer disease made more errors than neurologically normal drivers on a route-errors than neurologically normal drivers on a route-following task that placed demands on driver memory, following task that placed demands on driver memory, attention, and perception.attention, and perception. The The demands of following route demands of following route directions probably increased the cognitive load during directions probably increased the cognitive load during driving, which might explain the higher number of safety driving, which might explain the higher number of safety errorserrors..

Neurology. 2004 Sep 14;63(5):832-7. Neurology. 2004 Sep 14;63(5):832-7.

Safe Driving: Aging and Alzheimer’s DiseaseSafe Driving: Aging and Alzheimer’s DiseaseDavid Drachman David Drachman

EditorialEditorial

1. Driving most dangerous activity1. Driving most dangerous activity

2. Accident / 10 years (dependent upon alcohol use, 2. Accident / 10 years (dependent upon alcohol use, miles traveled, night driving, proximity to miles traveled, night driving, proximity to home, ? Age)home, ? Age)

3. ? Age./ ? Alzheimer’s disease3. ? Age./ ? Alzheimer’s disease

4.4. Age >75 years- 20% less than 16yoAge >75 years- 20% less than 16yo

5. Vision test, cognitive tests, CDR scale, on road 5. Vision test, cognitive tests, CDR scale, on road driving testdriving test

6. Mild Alzheimer’s V. Moderate Alzheimer’s6. Mild Alzheimer’s V. Moderate Alzheimer’s

Neurology. 2004 Sep 14;63(5):832-7Neurology. 2004 Sep 14;63(5):832-7..

Driving and Alzheimer’s diseaseDriving and Alzheimer’s diseaseRecommendations from the Recommendations from the

American Academy of NeurologyAmerican Academy of Neurology20002000

• Explain to patients and their familiesExplain to patients and their families that individuals with that individuals with Alzheimer’s Alzheimer’s disease (AD), scoring disease (AD), scoring >= 1.0>= 1.0 on Clinical Dementia Rating on Clinical Dementia Rating (CDR) scale(CDR) scale, , have have a a substantially increased accident rate and driving performance errorssubstantially increased accident rate and driving performance errors, and , and that disontinuation of driving should be strongly considered.that disontinuation of driving should be strongly considered.

• Explain to patients and their families that individuals with Explain to patients and their families that individuals with possible AD, possible AD, scoring 0.5 on the CDR scale, pose a significantly greater trafficscoring 0.5 on the CDR scale, pose a significantly greater traffic safety safety problemproblem than other older drivers. than other older drivers.

• Consider patients for referral to a Consider patients for referral to a qualified examiner for a drivingqualified examiner for a driving performance evaluation.performance evaluation.

• Reassess dementiaReassess dementia severity and appropriateness of continued driving severity and appropriateness of continued driving every every six monthssix months, because of the likelihood of progression to a CDR score , because of the likelihood of progression to a CDR score of 1.0 within a few years.of 1.0 within a few years.

Source: Dubinsky RM, Stein AC, Lyons K. Practice parameter: risk of driving Source: Dubinsky RM, Stein AC, Lyons K. Practice parameter: risk of driving and Alzheimer’s disease (an evidence based review). Neurology. and Alzheimer’s disease (an evidence based review). Neurology. 20002000;54:2205-2211.;54:2205-2211.

Clinical Dementia Rating (CDR) ScalClinical Dementia Rating (CDR) Scalee Alzheimer's Disease Research CenterAlzheimer's Disease Research Center Washington University, St. Louis Washington University, St. Louis

(Six domains: Memory, orientation, judgment and problem (Six domains: Memory, orientation, judgment and problem solving, community affairs, home and hobbies, personal-care)solving, community affairs, home and hobbies, personal-care)

““Cole Neuroscience-ExtrapolationCole Neuroscience-Extrapolation!”!”

CDR--0.0 = normal -- (MMSE mean 29)CDR--0.0 = normal -- (MMSE mean 29)CDR--CDR--0.50.5 = very mild dementia-Poss ( = very mild dementia-Poss (MMSE mean 24MMSE mean 24))CDR--CDR--1.0 1.0 = mild dementia –prob. (= mild dementia –prob. (MMSE mean 20MMSE mean 20))CDR--2.0 = moderate dementia -- (MMSE mean 11)CDR--2.0 = moderate dementia -- (MMSE mean 11)CDR--3.0= severe dementia -- (MMSE mean 5)CDR--3.0= severe dementia -- (MMSE mean 5)

Clinician Assessment of the Driving Competence Clinician Assessment of the Driving Competence of Patients with Dementiaof Patients with Dementia..

Ott BR, Anthony D, Papandonatos GD, D'Abreu A, Burock J, Curtin A, Wu CK, Morris Ott BR, Anthony D, Papandonatos GD, D'Abreu A, Burock J, Curtin A, Wu CK, Morris JC.JC.

Department of Clinical Neurosciences, Brown University, Providence, Rhode Island, Department of Clinical Neurosciences, Brown University, Providence, Rhode Island, USA. Brian_Ott@mhri.orgUSA. Brian_Ott@mhri.org

OBJECTIVES: To determine the validity and reliability of clinician ratings of the driving OBJECTIVES: To determine the validity and reliability of clinician ratings of the driving competence of patients with mild dementia. DESIGN: Observational study of a cross-section competence of patients with mild dementia. DESIGN: Observational study of a cross-section of drivers with mild dementia based on chart review by clinicians with varying types of of drivers with mild dementia based on chart review by clinicians with varying types of expertise and experience. SETTING: Outpatient dementia clinic. PARTICIPANTS: Fifty expertise and experience. SETTING: Outpatient dementia clinic. PARTICIPANTS: Fifty dementia subjects from a longitudinal study of driving and dementia. MEASUREMENTS: Each dementia subjects from a longitudinal study of driving and dementia. MEASUREMENTS: Each clinician reviewed information from the clinic charts and the first study visit. The clinician clinician reviewed information from the clinic charts and the first study visit. The clinician then rated the drivers as safe, marginal, or unsafe. A professional driving instructor then rated the drivers as safe, marginal, or unsafe. A professional driving instructor compared these ratings with total driving scores on a standardized road test and categorical compared these ratings with total driving scores on a standardized road test and categorical ratings of driving competence. Clinicians also completed a visual analog scale assessment of ratings of driving competence. Clinicians also completed a visual analog scale assessment of variables that led to their determinations of driving competence. RESULTS: Accuracy of variables that led to their determinations of driving competence. RESULTS: Accuracy of clinician ratings ranged from 62% to 78% for the instructor's global rating of safe versus clinician ratings ranged from 62% to 78% for the instructor's global rating of safe versus marginal or unsafe. In general, there was moderate accuracy and interrater reliability. marginal or unsafe. In general, there was moderate accuracy and interrater reliability. Accuracy could have been improved in the least-accurate raters by greater attention to Accuracy could have been improved in the least-accurate raters by greater attention to dementia duration and severity ratings, as well as less reliance on the history and physical dementia duration and severity ratings, as well as less reliance on the history and physical examination. The most accurate predictors were clinicians specially trained in dementia examination. The most accurate predictors were clinicians specially trained in dementia assessment, who were not necessarily the most experienced in their years of clinical assessment, who were not necessarily the most experienced in their years of clinical experience.experience.

Conclusion: Although a Conclusion: Although a clinicianclinician may be able to identify many may be able to identify many potentially hazardouspotentially hazardous drivers, drivers, accuracy is insufficientaccuracy is insufficient to suggest that to suggest that a a clinicians assessment aloneclinicians assessment alone is is adequateadequate to determine to determine driving driving competence in those with mild dementia.competence in those with mild dementia.

J Am Geriatr Soc. 2005 May;53(5):829-33.Related Articles, LinksJ Am Geriatr Soc. 2005 May;53(5):829-33.Related Articles, Links

To Drive or not to Drive: roles To Drive or not to Drive: roles of the Physician, Patient, of the Physician, Patient,

and Stateand StateMeador KJMeador KJ

Neurology. 2007 Apr 10;68(15):1170-1.Neurology. 2007 Apr 10;68(15):1170-1.

1. Regional differences of relative importance of an 1. Regional differences of relative importance of an individual’s right and public risk. (patch worth of state individual’s right and public risk. (patch worth of state laws)laws)

2. 2. Lack of evidence based medicine. Is the patient Lack of evidence based medicine. Is the patient competent or incompetent?competent or incompetent? ( (54% of patients with 54% of patients with epilepsy who crashedepilepsy who crashed were driving were driving illegally-illegally-competent!)competent!)

3. 3. No well established guidelines-howNo well established guidelines-how much cognitive much cognitive impairment represents an unacceptable risk?impairment represents an unacceptable risk?

4. 4. All relevant driving issues should be discussed with All relevant driving issues should be discussed with family/caregiverfamily/caregiver ie: competency and risk of injury to ie: competency and risk of injury to Self and Society.Self and Society.

5. The 5. The physician should notphysician should not be placed in the be placed in the primary role of primary role of enforcement.enforcement.

A longitudinal study of drivers with Alzheimer A longitudinal study of drivers with Alzheimer disease.disease.

Ott BR, Heindel WC, Papandonatos GD, Festa EK, Davis JD, Daiello LA, Ott BR, Heindel WC, Papandonatos GD, Festa EK, Davis JD, Daiello LA, MorrisMorris JC. JC.

Department of Clinical Neurosciences, Brown University, Providence, RI, USADepartment of Clinical Neurosciences, Brown University, Providence, RI, USA

OBJECTIVE: The goal of this study was to define the natural progression of OBJECTIVE: The goal of this study was to define the natural progression of driving impairment in persons who initially have very mild to mild dementia. driving impairment in persons who initially have very mild to mild dementia. METHODS: We studied 128 older drivers, including 84 with early Alzheimer METHODS: We studied 128 older drivers, including 84 with early Alzheimer disease (AD) and 44 age-matched control subjects without cognitive impairment. disease (AD) and 44 age-matched control subjects without cognitive impairment. Subjects underwent repeated assessments of their cognitive, neurologic, visual, Subjects underwent repeated assessments of their cognitive, neurologic, visual, and physical function over 3 years. Self-reports of driving accidents and traffic and physical function over 3 years. Self-reports of driving accidents and traffic violations were supplemented by reports from family informants and state violations were supplemented by reports from family informants and state records. Within 2 weeks of the office evaluation, subjects were examined by a records. Within 2 weeks of the office evaluation, subjects were examined by a professional driving instructor on a standardized road test. RESULTS: At baseline, professional driving instructor on a standardized road test. RESULTS: At baseline, subjects with AD had experienced more accidents and performed more poorly on subjects with AD had experienced more accidents and performed more poorly on the road test, compared to controls. Over time, both groups declined in driving the road test, compared to controls. Over time, both groups declined in driving performance on the road test, with subjects with AD declining more than performance on the road test, with subjects with AD declining more than controls. Survival analysis indicated that while the majority of subjects with AD controls. Survival analysis indicated that while the majority of subjects with AD passed the examination associated with higher rates of failure and marginal passed the examination associated with higher rates of failure and marginal performanceperformance. .

CONCLUSIONS: This study CONCLUSIONS: This study confirms previous reportsconfirms previous reports of potentially of potentially hazardous driving in hazardous driving in persons with early Alzheimer disease, but also persons with early Alzheimer disease, but also indicates that some individuals with very mild dementia can indicates that some individuals with very mild dementia can continue to drive safely for extended periods of time. Regular follow-continue to drive safely for extended periods of time. Regular follow-up assessments, however, are warranted in those individuals. up assessments, however, are warranted in those individuals.

Neurology. 2008 Apr 1;70(14):1171-8.Neurology. 2008 Apr 1;70(14):1171-8.

Investigation of Investigation of Anosognosia in Anosognosia in

Alzheimer’s diseaseAlzheimer’s disease

Investigation of Investigation of Anosognosia in Anosognosia in

Alzheimer’s diseaseAlzheimer’s disease

John H. Dougherty Jr., MDMattea de Leonni Stanonik, PhD

Charles A. Licata, MA

Cole Neuroscience CenterDepartment of Radiology

University of Tennessee Graduate School of MedicineUniversity of Tennessee Medical Center

John H. Dougherty Jr., MDMattea de Leonni Stanonik, PhD

Charles A. Licata, MA

Cole Neuroscience CenterDepartment of Radiology

University of Tennessee Graduate School of MedicineUniversity of Tennessee Medical Center

CAS-ADCAS-ADThe Cole Anosognosia Scale for Alzheimer’s The Cole Anosognosia Scale for Alzheimer’s

diseasedisease

An Instrument for Measuring An Instrument for Measuring Anosognosia in Alzheimer’s Anosognosia in Alzheimer’s

diseasedisease

AnosognosiaAnosognosia

Working Definition Working Definition 

Inability to recognize state of illness in Inability to recognize state of illness in

one’s own organism – one’s own organism – usually manifested as usually manifested as

unawareness of cognitive deficits in AD unawareness of cognitive deficits in AD

patients.  patients.  

Anosognosia in Alzheimer’s Anosognosia in Alzheimer’s diseasedisease

• Present research has shown the number Present research has shown the number

of AD patients suffering from of AD patients suffering from

anosognosia is approximately anosognosia is approximately 20%20%

(Migliorelli, Teson, and Sabe, 1995). (Migliorelli, Teson, and Sabe, 1995).

• Most researchers and clinicians believe Most researchers and clinicians believe

the number to be the number to be higher.higher.

• Our research show number as high as Our research show number as high as

40%.40%.

Why the need for an Why the need for an Anosognosia Instrument?Anosognosia Instrument?

• Patient Management:Patient Management:

– Understanding patient limitationsUnderstanding patient limitations

(anosognosia) (anosognosia) allows improved allows improved

assessment of patients with AD and assessment of patients with AD and

limited insightlimited insight. . (eg: Driving).(eg: Driving).

Unawareness of cognitive deficit (cognitive Unawareness of cognitive deficit (cognitive anosognosia) in probable AD and control anosognosia) in probable AD and control

subjectssubjects..

Barrett AM, Eslinger PJ, Ballentine NH,Barrett AM, Eslinger PJ, Ballentine NH, Heilman Heilman KM. KM.Department of Neurology, Pennsylvania State University College of Medicine, Department of Neurology, Pennsylvania State University College of Medicine,

Hershey, USA. abarrett@kmrrec.orgHershey, USA. abarrett@kmrrec.org

OBJECTIVE: To develop a quantitative method of assessing cognitive anosognosia in six cognitive and two OBJECTIVE: To develop a quantitative method of assessing cognitive anosognosia in six cognitive and two noncognitive domains. METHODS: Control (n = 32) and probable Alzheimer disease (pAD) (n = 14) subjects noncognitive domains. METHODS: Control (n = 32) and probable Alzheimer disease (pAD) (n = 14) subjects self-estimated memory, attention, generative behavior, naming, visuospatial skill, limb praxis, mood, and self-estimated memory, attention, generative behavior, naming, visuospatial skill, limb praxis, mood, and uncorrected vision, both before and after these abilities were assessed. Based on this estimate and their uncorrected vision, both before and after these abilities were assessed. Based on this estimate and their performance the authors calculated an anosognosia ratio (AR) by dividing the difference between estimated performance the authors calculated an anosognosia ratio (AR) by dividing the difference between estimated and actual performance by an estimated and actual performance sum. With perfect awareness, AR = 0. and actual performance by an estimated and actual performance sum. With perfect awareness, AR = 0. Overestimating abilities would yield a positive AR (< or =1); underestimation would yield a negative AR (> Overestimating abilities would yield a positive AR (< or =1); underestimation would yield a negative AR (> or =-1). RESULTS: Relative to controls, pAD subjects demonstrated anosognosia. Pre-testing (off-line), pAD or =-1). RESULTS: Relative to controls, pAD subjects demonstrated anosognosia. Pre-testing (off-line), pAD subjects overestimated their visuospatial skill; post-testing (on-line), pAD subjects overestimated their subjects overestimated their visuospatial skill; post-testing (on-line), pAD subjects overestimated their memory. Control subjects also made self-rating errors, underestimating their attention pre-testing and memory. Control subjects also made self-rating errors, underestimating their attention pre-testing and overestimating limb praxis and vision post-testing. overestimating limb praxis and vision post-testing.

CONCLUSIONS: This anosognosia CONCLUSIONS: This anosognosia assessmentassessment method may method may allow allow more detailed examinationmore detailed examination of of distorted self-distorted self-awarenessawareness. . These results suggest that screening for These results suggest that screening for anosognosia in probable Alzheimer’s disease anosognosia in probable Alzheimer’s disease (pAD(pAD) should ) should include self-estimates of visuospatial function, and include self-estimates of visuospatial function, and memory. memory.

Neurology. 2005 Feb 22;64(4):693-9.Neurology. 2005 Feb 22;64(4):693-9.

Critical Questions: Driving and Critical Questions: Driving and AD!AD!

1.Using the “1.Using the “best availablebest available” ” criteriacriteria- does a patient with- does a patient withAD have a high risk for driving-related accidents.AD have a high risk for driving-related accidents.

2. Is the AD patient 2. Is the AD patient competent or incompetentcompetent or incompetent?? Expressive choice beyond “yes or no”, Understand the Expressive choice beyond “yes or no”, Understand the

facts relevant to the proposed decision, Appreciate the facts relevant to the proposed decision, Appreciate the consequences of the decision, Provide rationalconsequences of the decision, Provide rational reasons for the decisionreasons for the decision) -“parking lot accidents”) -“parking lot accidents”

3. Does the AD patient have evidence of 3. Does the AD patient have evidence of anosognosiaanosognosia??

4. Has the 4. Has the patientpatient and and family/caregiverfamily/caregiver been told by the been told by the physician that he shouldphysician that he should not not drive?drive?

5. If the AD patient is 5. If the AD patient is involved in an accident with injury involved in an accident with injury and the patientand the patient –with the –with the knowledge of the family-knowledge of the family- has has been been told not to drivetold not to drive the patient or his the patient or his estate ( family)estate ( family)

can be can be held responsibleheld responsible!!

Driving and Alzheimer’s DiseaseDriving and Alzheimer’s DiseaseSummarySummary

• AD (moderate,?mild)AD (moderate,?mild) patients have patients have an increased crash an increased crash raterate compared to the general compared to the general elderly populationelderly population..

• DOT DOT estimates that estimates that elderly driverselderly drivers will increase from will increase from 10%10% to to 17%17% of the population by the year 2020. of the population by the year 2020.

• 50% of 50% of ADAD patients have a neurological condition patients have a neurological condition (Anosognosia) which actually (Anosognosia) which actually makes selfmakes self appraisalappraisal of of driving ability driving ability impossibleimpossible..

Driving and Alzheimer’s DiseaseDriving and Alzheimer’s DiseaseSummarySummary

• There is very There is very little researchlittle research from from evidence based evidence based medicinemedicine to establish parametersto establish parameters for sound and for sound and justjust determinations of driving abilities in patients with determinations of driving abilities in patients with Alzheimer’s disease.Alzheimer’s disease.

• No clear guidelinesNo clear guidelines for the physician, society or the law for the physician, society or the law to determine objective assessments for the to determine objective assessments for the balancebalance of of risksrisks and and benefitsbenefits to society as well as the to society as well as the individualindividual..

Driving and Alzheimer’s DiseaseDriving and Alzheimer’s DiseaseSummarySummary

• Any solution must Any solution must balance respectbalance respect for the for the patient patient with concern for their safety and that with concern for their safety and that of the families and society in general.of the families and society in general.

• Any solution should involve Any solution should involve a clinically tested a clinically tested diagnostic system.diagnostic system.

• Establish research from Establish research from evidence based evidence based medicinemedicine by using by using objective assessment toolsobjective assessment tools for driving skills.for driving skills.

Driving and Alzheimer’s diseaseDriving and Alzheimer’s disease““Tips” for managementTips” for management

1.Take professional responsibility1.Take professional responsibility

2. Be factual and definitive (~ 50% of patients 2. Be factual and definitive (~ 50% of patients have excellent insight and are often willing have excellent insight and are often willing to stop driving)to stop driving)

3. Write prescription! “No driving”3. Write prescription! “No driving”

4. No decisions “are forever”4. No decisions “are forever”

5. Have patients make a “follow-up” telephone 5. Have patients make a “follow-up” telephone callcall

6. Disable the car!6. Disable the car!

7. Have patient surrender drivers7. Have patient surrender drivers license! license!

Driving and Alzheimer’s DiseaseDriving and Alzheimer’s Disease

Computer Driving Simulation Computer Driving Simulation System (STISIM)System (STISIM)

Cole Neuroscience Center and Cole Neuroscience Center and the the Lederer FamilyLederer Family

• Provide critical objective data for clinical Provide critical objective data for clinical applicationapplication- - Is it safe for Is it safe for this individualthis individual with with Alzheimer’s disease to drive?Alzheimer’s disease to drive?

• A STISIM Model driving simulatorA STISIM Model driving simulator

• Provide support for PhD graduate and graduate level Provide support for PhD graduate and graduate level researchresearch

Driving and Alzheimer’s Disease Driving and Alzheimer’s Disease Alzheimer’s SymposiumAlzheimer’s Symposium,,

Dec. 8, 2011Dec. 8, 2011Lecture objectives:Lecture objectives:

1.1. Be able to identify objective clinical features Be able to identify objective clinical features which place Alzheimer’s patients at risk when which place Alzheimer’s patients at risk when

driving. driving. 2.2. Understand how Understand how anosognosiaanosognosia may contribute to may contribute to

driving risk in Alzheimer’s diseasedriving risk in Alzheimer’s disease3.3. Have a management strategy for dealing with Have a management strategy for dealing with

driving issues in impaired patients with driving issues in impaired patients with Alzheimer’s diseaseAlzheimer’s disease

Dr. John Dougherty Jr. is a member of the Dr. John Dougherty Jr. is a member of the Speakers Bureau for Eisai, Forest, Speakers Bureau for Eisai, Forest,

Novartis,and Pfizer pharmaceuticals.and Pfizer pharmaceuticals.

Alzheimer’s Disease Symposium Dec. Alzheimer’s Disease Symposium Dec. 8, 2011 8, 2011

DisclosureDisclosureJohn H. Dougherty Jr.John H. Dougherty Jr.