Driving & Dementia

from Austroads (updated 22 June 2022) – https://austroads.gov.au/publications/assessing-fitness-to-drive/ap-g56/neurological-conditions/dementia#aftd-b-6-1-3

🔹 Definition and Epidemiology

• Dementia = syndrome due to brain disease (usually chronic/progressive).
• Affects memory, thinking, orientation, comprehension, judgement, etc.
• Alzheimer’s disease = most common (60–70% of cases).
• Up to 8% of ≥60 year-olds affected; 9% are young-onset (<65 yrs).
• MCI and preclinical stages are distinguished from overt dementia.

🔹 6.1.1 – Relevance to the Driving Task

Impairments affecting driving:

• Poor navigation; getting lost.
• Gaps in attention; failing to observe road signs.
• Poor judgement; misjudging distances/speed.
• Confusion under stress; e.g. mixing up pedals.
• Poor decision-making; failure to give way or stop.
• Lack of insight/denial of deficits.
• Slowed reactions and poor hand–eye coordination.

Crash Risk Evidence:

• Dementia = moderately high crash risk.
• Not all patients need licence cancellation—individual assessment essential.
• Voluntary driving cessation is common with insight/family support.

🔹 6.1.2 – Assessment & Management Guidelines

Preclinical Dementia:

• Pathology without symptoms: fit to drive.
• Regular review advised.

Mild Cognitive Impairment (MCI):

• Slight decline in cognition; daily function usually preserved.
• Driving generally not impaired, unless multiple domains affected.

Dementia (diagnosed):

• Progressive & irreversible.
• Individualised assessment critical.
• Includes:
  • Medical review +/- specialist input.
  • Off-road and on-road driver assessments.
  • Review of history, vision, hearing, coordination, insight, mood.

When to Consider Practical Driving Assessment:

• Uncertainty or concern regarding functional driving ability.
• Family input may highlight red flags (e.g. crashes, reluctance to be driven by the person).

Transition Planning:

• Area-based licence restrictions may be appropriate in early stages.
• Discuss alternative transport (public, community, taxi schemes).
• Involve family in planning.

Failure to Comply with Advice:

• Denial/lack of insight may result in unsafe driving despite advice.
• Health professionals are indemnified if they notify licensing authority of at-risk drivers.

🔹 6.1.3 – Medical Standards for Licensing

Private Vehicle Drivers:

• Unconditional licence not allowed for diagnosed dementia.
• Conditional licence may be issued if:
  • At least annual review.
  • Info from treating doctor on cognitive domains (e.g. insight, visuospatial ability, memory).
  • Practical driving assessment if needed.

cognitive domains

Cognitive Domain	Description	Driving Relevance
Attention and Concentration	– Sustained, selective, and divided attention	– Focus during long drives – Filtering distractions – Handling multiple tasks while driving
Visuospatial Functioning	– Spatial awareness and visual perception	– Lane maintenance – Judging distances – Navigating turns and parking
Executive Function	– Planning, problem-solving, flexibility, judgment	– Responding to road hazards – Decision-making at intersections – Adapting to road changes
Memory	– Working and prospective memory	– Remembering routes and directions – Recalling traffic rules – Following multi-step instructions
Insight and Judgment	– Awareness of deficits and driving ability	– Recognising limitations – Avoiding unsafe driving – Willingness to self-regulate
Reaction Time / Psychomotor Speed	– Processing speed and motor response	– Braking promptly – Reacting to sudden events (e.g. pedestrian crossing)
Language and Communication	– Understanding and expressing language	– Reading road signs – Following verbal instructions – Communicating in emergencies

Practical Application

• Screening tools may include:
  • Mini-Mental State Examination (MMSE) – but note, MMSE alone is insufficient.
  • Addenbrooke’s Cognitive Examination (ACE-III) – more comprehensive.
  • Trail Making Test B, Clock Drawing Test – for visuospatial and executive function.
• Where appropriate, occupational therapy driving assessments or formal neuropsychological testing may be indicated.

Commercial Vehicle Drivers:

• Unconditional licence not allowed for diagnosed dementia.
• Conditional licence may be considered only with:
  • Annual review.
  • Specialist input.
  • Mandatory practical driver assessment.

MCI or Preclinical Dementia:

• Not included in “dementia” definition unless functional impairments are present.

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🔹 Licensing and Reporting Responsibilities

• Licensing authority makes final decision based on clinical input.
• Health professionals must:
  • Report impairments and limitations.
  • Consider multiple comorbidities.
  • Consider nature of driving (e.g. farmer vs. commercial interstate driver).
• Patients must be informed of:
  • Driving risks.
  • Legal obligation to notify licensing authority if driving is affected.