Many people with early dementia are capable of driving safely, and their physicians should consider overall ability to drive and individual lifestyle gains from driving versus safety risks in counseling patients and families, according to an article in the June 30 issue of BMJ.

According to background information in the article, surveys of drivers aged more than 80 years consistently show prudent driving behaviors. Furthermore, loss of independence with the end of driving can limit access to family, friends, and services and is an independent risk factor for entry into a nursing home.

British researchers reviewed available evidence and concluded that the risk of crashes in patients with dementia is acceptably low for up to three years after diagnosis. Thus, they proposed that any changes to United Kingdom licensing rules try to balance mobility and safety in the growing population of older drivers.

The Driver and Vehicle Licensing Agency currently states that anyone holding a driving license must, by law, inform the agency when given a diagnosis of any medical condition that might affect safe driving. Doctors must also complete a medical report, on which the agency will base their decision on fitness to drive.

Cognitive testing, however, cannot discriminate between people with early dementia and their ability to drive safely. Evidence from Scandinavia, Australia, and the United States also suggests that mass medical screening or cognitive screening of older drivers has negative consequences on public health.

Therefore, the authors suggest that the main thrust of future measures should focus on opportunistic screening of high risk populations, such as those attending specialist memory clinics, and the refinement of effective pathways for clinicians and the licensing agency to manage mobility and safety.