Document Detail


Predictors of driving cessation in mild-to-moderate dementia.
MedLine Citation:
PMID:  16966661     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementia-related factors associated with driving cessation. The purpose of our study was to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia.
METHODS: A 3-year prospective study, the Canadian Outcomes Study in Dementia (COSID) has enrolled 883 patients with mild-to-moderate dementia at 32 centres across Canada. Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for staging (severity), the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behaviour. Factors associated with the decision to quit driving after the baseline assessment were tested with Cox survival analysis.
RESULTS: Of 719 subjects who were or had been drivers, 203 (28.2%) were still driving at baseline. Over an observation period that averaged 23 months, 97 (48.5%) of 200 patients quit driving. Factors predictive of driving cessation included GDS (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.15-2.45), MMSE score (HR 0.90, 95% CI 0.83-0.97) and NPI findings (HR 1.63 for presence of > or = 3 behaviours, 95% CI 1.01-2.62). Among the NPI behaviours, when they were analyzed separately, agitation led to a decreased likelihood of driving cessation (p = 0.019), whereas apathy (p = 0.031) and hallucinations (p = 0.050) led to an increased likelihood.
INTERPRETATION: Cognitive impairment and behaviours such as agitation, apathy and hallucinations were significant predictors of driving cessation in patients with a mild to moderate degree of dementia. These findings should be considered when one counsels patients and their families.
Authors:
Nathan Herrmann; Mark J Rapoport; Robert Sambrook; Réjean Hébert; Peter McCracken; Alain Robillard;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  175     ISSN:  1488-2329     ISO Abbreviation:  CMAJ     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-09-12     Completed Date:  2006-10-12     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  591-5     Citation Subset:  AIM; IM    
Affiliation:
Sunnybrook Health Sciences Centre and the Department of Psychiatry, University of Toronto, Toronto, Ont. n.herrmann@utoronto.ca
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MeSH Terms
Descriptor/Qualifier:
Accidents, Traffic / statistics & numerical data
Aged
Aged, 80 and over
Aggression
Alzheimer Disease
Automobile Driving / statistics & numerical data*
Canada / epidemiology
Cluster Analysis
Dementia* / epidemiology
Female
Geriatric Assessment
Hallucinations / epidemiology
Humans
Licensure* / legislation & jurisprudence,  statistics & numerical data
Male
Multicenter Studies as Topic
Comments/Corrections
Comment In:
CMAJ. 2007 Jan 30;176(3):351   [PMID:  17261836 ]
CMAJ. 2006 Sep 12;175(6):601   [PMID:  16966663 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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