1. Dementia Type
Generally unsafe impact on executive function:
Lewy Body dementia (fluctuations, hallucinations, visuospatial problems)
Frontotemporal dementias (if associated with behaviour (decreased impulse control vs. apathy) or judgement issues)
2. Functional Impact of Dementia
Impairment of 2 or more IADL due to cognition.
Impairment of 1 or more personal ADLs due to cognition.
3. Family Concerns
-Near-misses with vehicles, pedestrians
-Confusing the gas and brake
-Missing stop signs/lights; stopping for green light
-Not observing during lane changes/ merging
-Collisions and/or damage to the car
-Deferring right of way inappropriately
-Others honking/irritated with the driver
-Needing a co-pilot
4. Visuospatial Issues
Intersecting pentagons on MMSE
Cube drawing on MOCA
5. Physical Limitations
Musculoskeletal problems, weakness/multiple medical conditions affecting:
–use of steering wheel/pedals,
–ability to move feet rapidly
–ability to feel the gas / brake pedals,
–level of consciousness
Severe, poorly controlled or rapidly changing conditions that can impact driving.
6. Vision/Visual Fields
Field of vision
7. Delirium Inducing Drugs
(Causing drowsiness, slow reaction time, lack of focus)
Alcohol, benzodiazepines, narcotics, neuroleptics, sedatives, anticonvulsants (Dilantin levels > 60)
Anticholinergics—antiparkinsonian drugs, muscle relaxants (flexiril, dantrolene), tricyclic antidepressants, antihistamine (OTC), antiemetics, antipruritics, antispasmodics, urinary (Ditropan) and others
8. Trail Making A and B
Trail A –Unsafe =>2 minutes or 2 or more errors
Trail B –Unsafe = >3 minutes or 3 or more errors (Unsure = 2–3 minutes or 2 errors)
9. Ruler Drop Reaction Time
2 failed trials out of 3 trials
Stroke(s), delirium, depression, Parkinson’s, Sleep Apnea
What would you do if you were driving and saw a ball roll out on the street ahead of you?
What special # would you call if you saw a fire in a house?
What would you do if driving and the light just turned yellow?
Other Red Flags
Hallucinations (should not drive)
Unsafe (Report as per legal requirements)