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10 Minute Dementia & Driving Checklist Cheat Sheet (DRAFT) by [deleted]

Determine when dementia patient should not drive

This is a draft cheat sheet. It is a work in progress and is not finished yet.

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

Absolute contra­ind­ica­tions
-Near-­misses with vehicles, pedest­rians
-Confusing the gas and brake
-Missing stop signs/­lights; stopping for green light
-Not observing during lane changes/ merging
Relative contra­ind­ication
-Colli­sions and/or damage to the car
-Getting lost
-Traffic tickets
-Deferring right of way inappr­opr­iately
-Others honkin­g/i­rri­tated with the driver
-Needing a co-pilot

4. Visuos­patial Issues

Inters­ecting pentagons on MMSE
Clock-­drawing test
Cube drawing on MOCA

5. Physical Limita­tions

Muscul­osk­eletal problems, weakne­ss/­mul­tiple medical conditions affecting:
–neck turn,
–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

Visual acuity
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

10. Judgem­ent­/In­sight

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)
Agitation
Anxiety
Apathy
Depression
Delusions
Disinh­ibition
Impuls­iveness

OVERALL FINDINGS

Safe
Uncertain safety
Unsafe (Report as per legal requir­ements)