Fitness to drive of older drivers with cognitive impairments

People are getting older and continue driving into very old age. In the ageing society, the number of persons with dementia is also increasing, and these persons wish to remain mobile as well. Importantly, not each patient with mild dementia is driving unsafely at the time of diagnosis. Many patients prefer to continue driving, but it is difficult for physicians to determine whether an individual patient is still driving safely.

This thesis addresses a new strategy to assess fitness to drive in a clinical setting. A fitness-to-drive assessment including clinical interviews, neuropsychological tests, and driving simulator rides is a promising approach for patients with Alzheimer’s disease. In over 90% of patients with Alzheimer’s disease, the strategy could predict correctly whether patients would pass or fail an official on-road driving assessment. Many factors play a role here, including the severity of dementia, reaction time, knowledge of traffic rules and hazard perception. Additionally, for patients with different types of dementia (e.g. vascular dementia, frontotemporal dementia, Lewy body dementia) different assessment strategies must be developed to evaluate their fitness to drive. Driving recommendations given after fitness-to-drive assessments effectively promoted driving continuation of patients who were fit to drive and driving cessation of patients who were no longer fit to drive. In the process of driving cessation, patients with dementia may benefit from support to stimulate and facilitate the transition to alternative transportation, in order to retain mobility and social participation.