Driving & Dementia
Driving involves several types of brain activities. These activities have to work together. A problem in one area can jeopardize the whole process.
Driving definitely relies on procedural memory. Procedural memory is the memorization of all of the steps to do something. We create procedural memory by doing a specific task daily or multiple times a day over decades. Over time, the procedural memory becomes automatic. A great example is learning to tie shoelaces. I remember teaching each of my 3 children how to tie their shoes. It took hours. Each child would face the task of tying their shoelaces with deadly seriousness and evidence of concentration. Over time, it became easier and easier. By the time they entered the first grade, tying shoelaces had become a procedural memory which meant they used very little brain power to complete the task.
Procedural memory acts like brain “autopilot”. This frees up the brain’s energy to focus on other activities, like planning (“what should I pull out for dinner tonight?”) and problem-solving (“how do I keep the damn deer from eating my sunflowers?”). If we had to concentrate on brushing our teeth, wiping our butts after pooping, dressing ourselves, making coffee, feeding the cats, feeding the dog, tossing laundry in the washer, emptying the dishwasher–we would be exhausted 20 minutes after getting up in the morning. Instead, thanks to procedural memory, I can do all of the above almost simultaneously (except for the poop part…that’s just gross…although I did see a hilarious YouTube of someone attending a Zoom meeting on the commode).
All of us rely on procedural memory when we drive familiar routes. Ever have the experience of arriving at your destination and realizing you have no idea how you got there? Because your mind was preoccupied with something else during the drive? Or my personal favorite, have you found yourself halfway to work on a Sunday morning instead of heading to the park–because you were daydreaming or talking and you went on “autopilot” instead of paying attention to making that right to go south (the park) instead of that left to head north (towards the job)? If so, thank your procedural memory!!
When something sudden or unusual occurs during the drive, other brain activities jump in. A crash up ahead? Ok, I’ll jump off the exit ramp and reroute my drive. I may have to retrieve old memories from my previous experiences of taking this route. Or, if I’ve never used this detour, I have to bring in my working memory to “hold onto” the general direction I need to travel in order to arrive at my destination. I also have to access my concentration and visual-spatial brain parts because I have to generate the “map” of the detour into my conscious mind, plan the route, and implement it–all the while maneuvering around the other 100 drivers with the same idea. My procedural memory continues to run in the background because I’m using the procedural memory to handle the basic mechanics of driving (start/stop, turn, use turn signal).
If I have any brain problems in any of these important areas–working memory, concentration, attention, retrieval, and visual-spatial–I lose my ability to successfully arrive at my destination in spite of a detour. I may keep going around in circles. I may forget my destination and have no idea where I am going–which causes anxiety and slows down retrieval, attention, and concentration. I may fail to react quickly to debris in the road, or I may over-react and change lanes, hitting the vehicle next to me.
Now that I’ve explained how driving involves a “dance” between procedural memory and other parts of the brain, I want you to think about the person living with dementia. Do they have short-term memory problems? Problems with road rage or impulsivity? Problems knowing the day of the week? The month? The year? Any of these problems are a red flag that their ability to drive needs further evaluation.
These next questions can also guide the decision:
- Is the person with dementia getting lost in familiar places?
- Any recent accidents or “near-misses”?
- Any new damage showing up on the car?
- Any impulsive or road-rage behaviors?
- Sudden pattern of traffic violations?
- Would you feel comfortable riding as a passenger if the person with dementia were driving?
- Would you feel comfortable having your child or grandchild as a passenger if the person with dementia were driving?
A “yes” response to #1 is a definite NO, the person should not be driving. #2 and #3 require more investigation for PATTERNS of recent accidents or near-misses, as well as consistent new damage on the car. When thinking about recent accidents or near-misses, was the person living with dementia at fault? Did time of day or weather play a factor? Sometimes people living with dementia have to restrict their driving to daytime only and avoid driving during busy times, on interstates, and during bad weather.
#4 and #5 can be red flags for frontotemporal dementia. A family member became concerned after her husband received 3 speeding tickets in the mail within a month. He had driven for 40 years with zero speeding tickets–and he often drove all over the country as part of his business. #4 suggests that the person should not be driving. I put in #4 because I’ve had experiences with persons with frontal lobe problems who became overly aggressive and literally tried to run another driver off of the road. I also recognize that a “yes” to #4 would apply to many people without a dementia diagnosis having their licenses revoked–no argument here!
A “no” response to #5 or #6 is a definite NO THE PERSON SHOULD NOT BE DRIVING. I guess you could make the argument that any driver, regardless of cognitive abilities, getting a “no” to #5 or #6 has no business behind the wheel of a car!!
What if there seems to be no problems with driving in spite of problems with memory?
This is a little trickier. The safest approach is to limit driving to local, well-known places that the person has driven to for years (supermarket, barber shop, hair salon, church). It may also be a good idea to avoid busy highways and interstates and to drive only during daylight and in good weather. Someone should regularly ride as a passenger to make sure the driving is still OK.
I completely understand how important personal freedom is to all of us, especially persons with dementia. But if a person with dementia is unaware of his or her driving problems, you are going to have to take away the keys. In some cases, you may even have to remove the car because hiding or removing the keys is often not enough. I recently encountered a situation where an adult daughter let her mom hold the working key fob. When daughter started unloading the groceries, mom slipped into the driver’s seat, turned on the car, and drove away. After that, the battery was removed from mom’s key fob. The daughter had been so worn down by her mother’s arguments, and mom’s refusal to hand over the key fob, that she let her mother keep the key fob. I recommended telling mom that the battery needed replacement, remove the battery, and return the key fob. So far, so good.
Bottom line: if you have questions or concerns about whether or not a person with dementia should be driving, talk to your primary care provider, a clinician (physician, nurse practitioner, physician’s assistant) experienced with dementia care, or even local law enforcement.
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Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.