Current status and problems of driving in elderly with cognitive decline in Okayama.
Background: Because cognitive decline increases the risk of traffic accidents, elderly people with dementia are prohibited from driving in Japan. However, criteria for determining whether patients with mild cognitive impairment (MCI) can continue driving have not been established. Car driving is an important tool for social and daily activities, especially for people living in suburbs who lack support with mobility from family members. Therefore, prohibiting driving could result in social isolation and severely impact the quality of life of elderly people. From April 2017, we established a specialized outpatient clinic to evaluate cognitive ability in the context of driving for elderly people who categorized as possible dementia by the National Public Safety Commission, and the people who suspected cognitive decline. Based on those data, we try to clarify the current situation about driving in cognitive declined elderly in Okayama, and discuss the relationship between driving and clinical characteristics of these people for future establishment of better criteria to prohibit driving among older adults with suspected cognitive impairment. Methods: From April 2017 to August 2021, we retrospectively examined the medical records of 61 patients (58 men; mean age, 80.5 ± 5.1 years) who visited our clinic for a cognitive evaluation in relation to driving. We compared clinical and neuropsychological characteristics between patients who continued driving and those who had stopped, with the goal of identifying criteria for determining the eligibility to drive. Results: We diagnosed 26.2% of the patients with dementia and 73.8% with MCI. Neuropsychological tests revealed that global cognitive impairment was typically not severe, although severe impairment was observed in several cognitive sub-categories in some patients, including attention, frontal lobe function, visuospatial processing, and executive function. We attempted to persuade all patients to give up driving; however, only 20 did so immediately after diagnosis. Of the remainder, 20 patients (19 males; mean age, 78.9 ± 4.4 years) continued to drive and were retested in our clinic every 6 months. In comparison with the patients who continued driving, those who gave up showed more severe impairment according to the Mini-Mental State Examination-Japanese version, Dementia Assessment Sheet in Community-based Integrated Care System, Clinical Dementia Rating, Frontal Assessment Battery, Trail Making Test-Japanese version, and Kohs Block Design Test. Conclusions: Despite current legal criteria enable MCI patients to continue driving, our data indicated that they tend to return their driver’s license when they have cognitive declines in multiple domains. It suggests that detailed cognitive assessment using multiple neuropsychological tests may help convince cognitively impaired patients to return their driver’s licenses.