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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

(2017) ACTA NEUROLOGICA BELGICA. 117(4). p.811-819
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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.
Keywords
driving, dementia, alzheimer’s disease, neurodegeneration, MILD COGNITIVE IMPAIRMENT, OLDER-ADULTS, CRASH RISK, FRONTOTEMPORAL DEMENTIA, DEPRESSIVE SYMPTOMS, DRIVERS, HEALTH, PERFORMANCE, CESSATION, FITNESS

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Citation

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Chicago
Versijpt, Jan, Mark Tant, Ingo Beyer, Jean-Christophe Bier, Patrick Cras, Peter P. De Deyn, Patrick De Wit, et al. 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.” Acta Neurologica Belgica 117 (4): 811–819.
APA
Versijpt, Jan, Tant, M., Beyer, I., Bier, J.-C., Cras, P., De Deyn, P. P., De Wit, P., et al. (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. ACTA NEUROLOGICA BELGICA, 117(4), 811–819.
Vancouver
1.
Versijpt J, Tant M, Beyer I, Bier J-C, Cras P, De Deyn PP, et al. 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. ACTA NEUROLOGICA BELGICA. 2017;117(4):811–9.
MLA
Versijpt, Jan, Mark Tant, Ingo Beyer, et al. “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.” ACTA NEUROLOGICA BELGICA 117.4 (2017): 811–819. Print.
@article{8533345,
  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.},
  author       = {Versijpt, Jan and Tant, Mark and Beyer, Ingo and Bier, Jean-Christophe and Cras, Patrick and De Deyn, Peter P. and De Wit, Patrick and Deryck, Olivier and Hanseeuw, Bernard and Lambert, Margareta and Lemper, Jean-Claude and Mormont, Eric and Petrovic, Mirko and Picard, Gaetane and Salmon, Eric and Segers, Kurt and Sieben, Anne and Thiery, Evert and Tournoy, Jos and Vandewoude, Maurits and Ventura, Manfredi and Verschraegen, Jurn and Engelborghs, Sebastiaan and Goffin, Tom and Deneyer, Michel and Ivanoiu, Adrian},
  issn         = {0300-9009},
  journal      = {ACTA NEUROLOGICA BELGICA},
  language     = {eng},
  number       = {4},
  pages        = {811--819},
  title        = {Alzheimer{\textquoteright}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},
  url          = {http://dx.doi.org/10.1007/s13760-017-0840-5},
  volume       = {117},
  year         = {2017},
}

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