Do mild cognitive impairment and driving make a dangerous mix? Not in most cases, health experts say.
For someone with MCI, that can be welcome news.
After all, mild cognitive impairment is a frightening diagnosis. Many worries race through your head, one of the first being: “Can I still drive?”
It’s a loaded question, and one you need to consider carefully. But don’t assume the worst. Unlike Alzheimer’s disease, this milder form of cognitive decline usually doesn’t mean you have to quit driving.
People with mild cognitive impairment typically aren’t a danger on the road. On average, they aren’t any more likely to have an accident in the first year or two after a diagnosis, and many continue to drive safely for years.
Mary Kay Baum is proof of that. A retired Lutheran pastor living in Wisconsin, she stopped working in 2006, a year after she was diagnosed with mild cognitive impairment. Yet more than a decade later, at the age of 70, she remains safe behind the wheel.
“I actually think I’m a better driver than most people my age who I would be a passenger of,” Baum says. “Because my mild cognitive impairment has stabilized and is now considered not progressive, I feel I’m going to be driving well for the foreseeable future.”
Still, Baum understands the potential risks of driving with a cognitive impairment. She’s never had an accident, but a near-collision three years ago led her to voluntarily undergo a driving assessment. She passed that test with flying colors and continues to drive — with certain restrictions she’s put on herself.
That’s what made sense for Baum, but every case is different. So to help you make the best decision for you and your situation, here are some important things to consider about mild cognitive impairment and driving, beginning with a look at all the things working in your favor.
Older adults are careful drivers to begin with. Despite the occasional news report about some 90-year-old who drives his car through the front window of a convenience store, older people are among the safest drivers on the road. Recently licensed teen-agers have far higher accident rates, as do people in their 30s, for that matter.
What’s more, driving is what brain experts call an “over-learned” skill. The experience we gain from 30 or 40 plus years behind the wheel is seared deep into our brain circuitry, and most of us can continue to access that ability even in the face of some cognitive loss.
When you put that together, it becomes easier to understand why there’s no evidence that having MCI will necessarily impair your driving skills to the point where you’re unsafe on the road.
To be fair, not much research has been done on the question. So a team of Australian researchers recently looked at 57 adults over the age of 65 who had mild cognitive impairment and compared them to 265 adults of similar age who were cognitively normal. All of the participants took a battery of tests, including an on-road driver evaluation.
In a paper published in the Journal of Alzheimer’s Disease in April, the researchers said although the people with MCI scored slightly lower, the difference was insignificant and both groups scored high enough to be considered safe drivers. Nor did the people with MCI report having more accidents than those who were cognitively normal. The conclusion: “Adults with MCI exhibit a similar range of driving ability to (cognitively normal) adults.”
Of course, that doesn’t mean every person diagnosed with MCI is safe to drive (any more than it means every older adult who falls within the cognitively normal range is a safe driver).
But it does underscore how different the question of mild cognitive impairment and driving is, when compared to the question of Alzheimer’s and driving. Those are two entirely different propositions, and the rules of the road are different, too.
When the diagnosis is Alzheimer’s, the ability to continue driving is definitely compromised. Some Alzheimer’s patients — about one in three — may still be able to drive in the first couple of years after they begin to show symptoms. But as soon as the diagnosis occurs, the doctor usually is required to report that to the local motor vehicle commission and the person must pass a driving test in order to stay behind the wheel.
For a diagnosis of mild cognitive impairment, no such test is required. Both the American and Canadian Medical Associations have taken the position that a diagnosis of cognitive impairment does not warrant a loss of driving privileges. No one is even required to report the diagnosis.
As a matter of public policy, that makes sense for a lot of reasons — not the least of which is that roughly 25 percent of people first diagnosed with MCI have their memory test normal the next time they’re evaluated, and about half may see their memory return to normal at some point. Challenging that person’s right to drive in the interim is simply not justified.
So no one is coming to take your driver’s license away based on a diagnosis of MCI. Whether you continue to drive is your decision, with input from your family and your doctor.
It’s a question May Kay Baum has weighed carefully since she was first diagnosed in 2005. “I wasn’t worried at the time that I’d soon need a driver’s exam, because we we’re talking about pretty subtle symptoms,” she says. “But I figured I would have to deal with it eventually.”
That reckoning came in 2014, when she nearly collided with another car. Pulling out of her driveway, she failed to see a neighbor coming down the road and had to brake hard to avoid an accident. She was living in a housing co-op in rural Wisconsin and the neighbor reported the incident to the co-op. The board was aware of her diagnosis, and already had concerns not only about her driving, but about her safety when she was walking or driving her ATV in the woods to pursue her passion for nature photography.
Baum was determined to face the issue head-on. So in December 2014 she made an appointment at the Occupational Therapy Clinic at Meriter Hospital in Madison for a rigorous driving evaluation. The process took 95 minutes, although she says it felt like “two or three hours.” They tested everything from depth perception and peripheral vision to reaction time and ability to maintain attention. She was found to have “good potential to return to driving” and proceeded to take a road test, which she also passed handily. The driving evaluator wrote, “Overall, the client demonstrated very good driving skills.”
While Baum remains on the road, and has had no accidents or near-misses since, she does restrict her driving. “Because of my cognitive changes, I felt I should not drive more than 3 hours in a day,” she says. “I tire more quickly than I used to.”
Like Mary Kay Baum, you want to choose wisely and safely, but the prevailing evidence says a person with MCI often can continue to drive, and you are allowed to begin with that presumption.
As you consider what makes sense for you, here are six tips to keep in mind:
- Get the opinion of others, and ask them to be candid. Because I’m an older adult, I’m allowed to say this, but we older adults aren’t always the best judge of our own driving ability.
- When possible, try not to drive alone. Having someone else in the car can be helpful.
- Consider whether you should put any restrictions on yourself, such as not driving at night or avoiding certain roads where the speed or traffic volume might stress you in a way that affects your driving.
- If you have to travel somewhere you’re not familiar with, particularly a longer distance, have a plan for how you’re going to safely navigate that, and try to have another driver in the car with you.
- Know the nature of your diagnosis, and its implications for driving. A recent study of 24 people with cognitive impairment found those who only had memory problems performed about as well as cognitively normal people in simulated driving tests. However, those who had other cognitive issues, such as problems with visual perception or planning, were more likely to have trouble staying in their lane, or turning left when there’s oncoming traffic. So know what cognitive functions are affected, because that might have a bearing on your ability to drive.
- Understand that even if you can drive safely now, you may not always be able to. Be alert for signs that your driving skills may be slipping, and ask your spouse or family to do the same. If you feel yourself becoming less confident behind the wheel, or others are beginning to express concern, consider having your driving evaluated. (Want to know what the most common warnings signs are? Use the form below to get my tip sheet “20 Warning Signs of Unsafe Driving.” It’s absolutely free when you sign up for my weekly newsletter.)
Once you’ve weighed these considerations, I’d love to hear what you decided. Will you keep driving? What influenced your decision? Do you have insights or suggestions to share with others facing this question? I invite you to leave a comment below, or send me an email. I look forward to hearing from you.