Driving and FTD

Driving is a complex, highly demanding activity

Driving involves performing multiple activities at the same time.  We must pay attention to other traffic as well as pedestrians, and instantaneous decision-making and judgment are needed to avoid potential dangers and threats.  Often it is necessary to infer the intentions of other drivers and pedestrians in order to anticipate and avoid a potentially dangerous situation.  Decision-making and judgment involves more than simply braking, and multiple factors must be weighed and judged very quickly in order to make a rapid response.  Traffic signals and signs must be detected and interpreted as well.  At the same time, we have to steer the car in a spatially appropriate manner to minimize the risk of hitting objects or injuring other drivers and pedestrians.  Steering must be coordinated with speed to optimize safe driving. 

Frontotemporal degeneration  is a significant risk factor for dangerous driving

Receiving a diagnosis of Frontotemporal degeneration (FTD) should not entail an immediate end to driving, but the progressive nature of the condition will render all patients unable to drive eventually. In particular, the changes in behavior and impairment in judgment characteristic of FTD mean that individuals often pose a significant risk behind the wheel. Medical studies of simulated driving indicate that individuals with FTD have significant difficulty with behavior and rapid judgment that place them at very high risk for injuring or killing themselves and others. 

The surest way to assess a person’s ability to drive safely is through a driving evaluation by a professional.   During a comprehensive driving evaluation, a neuropsychological assessment evaluates specific aspects of cognition and behavior that contribute to safe driving such as dual-tasking and executive functioning, visuospatial processing, and information processing speed.  Knowledge of driving rules and recognition of driving signs are assessed.  Often a driving simulator resembling an arcade game is used to assess some of the simpler aspects of driving.  Finally, an on-road driving is performed.

Techniques for reducing and eliminating driving

For many people driving signifies independence, so it can be difficult to convince a loved one with FTD to give up the car keys. This is why it is important to begin discussing the prospect of gradually limiting and finally ceasing driving early on in the course of the condition rather than later. This approach will provide more time to implement driving plans and reduce distress later on. Effort should be made to actively include your relative or loved one in this discussion early in the course of FTD, as this will increase the likelihood of adherence to the driving guidelines that will become necessary and give them a chance to voice their own concerns. Caregivers should take opportunities to observe and document changes they notice in the ability to drive and to share these observations in a non-judgmental manner with the patient, other family members or healthcare providers.

The most effective way to limit or stop an individual with FTD from driving is to do so gradually during the early stage of the disease. Families, friends or other caregivers can work to reduce patient’s need to drive by providing rides.  Friends or family members called upon to assist with rides will be most helpful if the appointments are made at the driver’s convenience, but this can be quite inconvenient to assistants.  An alternative is to schedule regular assistance at times of the day that are traditionally most helpful for performing activities such as shopping.  Additionally, caregivers can arrange for alternative modes of transportation.  Public transportation is often ideal for those with mild dementia, but may be too complicated for those in later stages of dementia.  Community transit services are available in many communities, and these can be scheduled for convenient times.  In using taxis, it is helpful if the driver has explicit instructions and if the patient has someone to meet at the beginning and end of each ride.