Driving is a major issue for people with dementia and their relatives. In all but the most urbanized areas, a car represents independence and may even be a necessity. But it is also a threat to the lives of the driver, the passengers, and those he may inadvertently hit if he is no longer a safe driver.

The question about the ability of the person with dementia to continue to drive comes up as soon as the diagnosis is made, and sometimes even before. Others may have noticed changes in the way the person handles the car, if he is able to follow directions, and how often he gets lost on the way to familiar places. Sometimes friends and relatives will refuse to ride in the car if the person with dementia is driving, and give a variety of excuses rather than say that they no longer feel safe with her behind the wheel.

There are many reasons that family members are reluctant to acknowledge that the person with dementia should no longer drive. Perhaps no one else is able to drive and no other means of transportation is readily available. They may want to protect the feelings and dignity of the person with the diagnosis of dementia. They may explain minor accidents by blaming the situation or other drivers.

Stopping driving need not be a sudden event. It is best if it is a step-wise process. In the early stages of dementia, the person may be safe driving in very familiar areas. Perhaps someone can drive behind him once a month to check his driving, and let you know if he feels it is still safe. In cases of disagreement, an on-road driving test may help the family, and possibly the person with dementia, accept that she is no longer competent to drive.

While the reluctance to take the keys away is understandable, not taking them may lead to serious injury to the person with dementia or to other people. Laws differ from state to state regarding the responsibility of doctors and family members to have the driving skills of a person with dementia evaluated and then, if necessary, to have the license revoked. All states allow health professionals and others to report individuals they believe to be medically unfit to drive due to dementia or other conditions. This reporting is anonymous. After a report has been filed the subject of the report will be notified. She then must prove she can still drive safely. She may have to retake the standard on-road driving safety test.

Signs that the person is no longer a safe driver include:

• braking often for no apparent reason
• missing signs and signals
• getting angry easily
• swerving in and out of lanes and getting lost in familiar places
• crashes
• dents on car
• not reacting to traffic signs
• driving too fast or too slow
• poor judgment
• turning around to talk to the person in the back seat and forgetting that he is driving