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You’ve just seen your doctor, and you’ve been diagnosed with mild cognitive impairment or Alzheimer’s disease. Does that mean you shouldn’t be driving?

Driving is a complicated skill and a dangerous activity. Almost 43,000 people died in motor vehicle crashes in the U.S. in 2021.

In addition to good physical health, driving requires many brain systems to function together.

The thinking part of your brain consists of four pairs of lobes — occipital, temporal, parietal and frontal — in the left and right hemispheres of the brain, and all of them are active when you are driving.

Once you’ve learned to drive, most of your routine driving occurs automatically and unconsciously. This is why, if you become distracted while driving, you may find yourself heading to the grocery store on autopilot when you meant to go to the doctor’s office. Your conscious mind takes control, however, whenever the situation requires it.

How dementias affect driving

Alzheimer’s disease and other forms of dementia affect a variety of different brain regions, including all four lobes of the brain. For this reason, people with Alzheimer’s disease often show impaired visual, auditory, attention and decision-making abilities.

However, not everyone with Alzheimer’s must stop driving. It depends on both the overall severity of the disease, as well as the specific cognitive abilities that are impaired.

One study found that people with Alzheimer’s had an average of 0.09 car crashes per year, compared to 0.04 crashes in age-matched healthy adults. Another study found that individuals with early Alzheimer’s had impairments similar to 16-to 20-year-old drivers.

So, on the one hand, people with Alzheimer’s are at increased risk while driving. On the other hand, when Alzheimer’s is very mild, accident rates are like those of new drivers — a group we as a society allow to drive with few or no restrictions.

Factors to consider

The American Academy of Neurology has published guidelines to help clinicians know when individuals with Alzheimer’s and other dementias should stop driving.

The guidelines suggest that clinicians consider the following factors, as the risk of accidents increased when more of these factors were present:

• Do caregivers report marginal or unsafe driving skills?
• Is there a history of citations?
• Is there a history of crashes?
• Are they driving under 60 miles per week?
• Do they avoid driving in certain situations?
• Do they show aggression or impulsivity in their driving?
• Is their cognition impaired on standard testing?
• Is there evidence of other factors that can impair their driving, such as alcohol use, medications that cause cognitive impairment, sleep disorders, visual impairment or motor impairment?

My advice: If you have been diagnosed with a memory disorder, ask a family member (or close friend) to ride in the car with you each month.

One of your adult children would be best. If your children feel comfortable with your driving, that usually means you’re driving safely.

Note that I am not concerned if you make a wrong turn or get lost. If you get lost, you can use a GPS or phone app or ask someone for directions.

I’m only concerned that you are a safe driver and are not endangering yourself or others on the road.

What if your family feels your driving is unsafe, but you believe you are a good driver? Take a driving test at your local registry of motor vehicles office or a rehabilitation hospital. That will allow you to prove to your family that you are a safe driver.

If you don’t pass the test, be courageous enough to hang up your keys. Take a taxi, use a rideshare app, or — even better — ride with a friend.

Andrew E. Budson, M.D., is a contributor to Harvard Health Publishing and an editorial advisory board member.

© 2023 Harvard University. Distributed by Tribune Content Agency, LLC.