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Driving and dementia: a clinician's guide

  • Sarah Wilson and Gill Pinner
Summary

With an ageing population and more drivers on the road, the number of drivers with dementia is due to grow exponentially over the next 50 years. Although decisions regarding possession of a driving licence in the UK are made by the Driver and Vehicle Licensing Agency (DVLA), psychiatrists have a duty to advise patients who are unfit to drive to cease driving and to inform the DVLA of patients who pose a risk to the public by continuing to drive when advised not to. This article offers a review of the literature on dementia and driving and summarises the evidence and advice for navigating this minefield. The use of psychological test batteries in clinical practice is discussed, along with the most useful questions to ask in memory clinics. Legal guidance for various countries is considered, as is the important (but often overlooked) issue of helping older people prepare for retirement from driving.

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Copyright
Corresponding author
Dr Sarah Wilson, Nottinghamshire Healthcare NHS Trust, Community Mental Health Team for Older People, Heather House, 72 Portland Street, Kirkby in Ashfield, Nottinghamshire NG17 7AG, UK. Email: sarahjw82@doctors.org.uk
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Declaration of Interest

G.P. is Associate Dean for Education and Training Standards at the Royal College of Psychiatrists.

Footnotes
References
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Driving and dementia: a clinician's guide

  • Sarah Wilson and Gill Pinner
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eLetters

Re:Mild Cognitive Impairment and Driving

Sarah Wilson, ST5 in Old Age Psychiatry
15 March 2013

We thank Dr Eggar for his comments regarding our article on Driving and Dementia [1]. As this is a rapidly developing area the DVLA is constantly revising its advice for drivers as we learn more about driving with dementia and cognitive impairment. This article was originally submitted in November 2011, and referred to the DVLA's August 2010 editionof the At a Glance Guide to the Current Medical Standards of Fitness to Drive, which only briefly mentioned cognitive impairment as a miscellaneous condition at the end of the guide.

Since then Mild Cognitive Impairment has been included as a medical condition in it's own right. Dr Eggar rightly quotes the May 2012 guidelines that state "Where an objective impairment is present or specific treatment is required then notification should be made to allow enquiries to take place." This may be apparent for some patients still under investigation prior to formal diagnosis.

However, the guidelines have been recently updated again. The March 2013 edition has been reworded stating "If there are no effects on drivingthen the DVLA does not need to be notified; if however there are any concerns that driving may be adversely affected then DVLA should be notified to allow enquires to take place." [2]

It is important that the DVLA is informed as early as possible in theassessment process. Informing patients of the need to contact the DVLA isa first step in the process of addressing driving retirement.

This serves as a good reminder for clinicians to keep up to date withthe most recent DVLA Medical Standards of Fitness to Drive, as they are constantly being revised, and as Dr Eggar points out, we may be open to criticism or legal action should we give the wrong advice.

Dr Sarah Wilson and Dr Gill Pinner

1.Wilson S, Pinner G. Driving and dementia: a clinician's guide. AdvPsychiatr Treat 2013; 19: 89-96.

2.Driver and Vehicle Licensing Agency (2013) For Medical Practitioners: At A Glance Guide to the Current Medical Standards of Fitness to Drive. DVLA. http://www.dft.gov.uk/dvla/medical~/media/pdf/medical/at_a_glance.ashx

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Conflict of interest: None declared

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Mild Cognitive Impairment and Driving

Richard J Eggar, Consultant Old Age Psychiatrist
15 March 2013

The Current DVLA guidance for Medical Practitioners (May 2012)concerning Mild Cognitive Impairment states 'Where an objective impairment is present or specific treatment is required then notification should be made to allow enquiries to take place." Most patients in the process of assessment for possible dementia will demonstrate objective evidence of impairment. In most cases therefore patients should be informing the DVLA of their cognitive difficulties even before a firm diagnosis is reached. By omitting this, the article appears to maintain the commonly held misconception that the DVLA need only be informed once aclear diagnosis is reached.

It is important that readers are made aware of this as it may lead them to delay giving the correct advice to their patients and possible expose the doctor to criticism or legal action.

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Conflict of interest: None declared

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