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05.10.2017 | Consensus paper and Guideline | Ausgabe 4/2017

Acta Neurologica Belgica 4/2017

Alzheimer’s disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association

Zeitschrift:
Acta Neurologica Belgica > Ausgabe 4/2017
Autoren:
Jan Versijpt, Mark Tant, Ingo Beyer, Jean-Christophe Bier, Patrick Cras, Peter P. De Deyn, Patrick De Wit, Olivier Deryck, Bernard Hanseeuw, Margareta Lambert, Jean-Claude Lemper, Eric Mormont, Mirko Petrovic, Gaetane Picard, Eric Salmon, Kurt Segers, Anne Sieben, Evert Thiery, Jos Tournoy, Maurits Vandewoude, Manfredi Ventura, Jurn Verschraegen, Sebastiaan Engelborghs, Tom Goffin, Michel Deneyer, Adrian Ivanoiu

Abstract

Alzheimer’s disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.

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