oa The evaluation of medical fitness to drive in patients with dementia, post-stroke conditions, or seizures

Safe automobile driving requires sufficient vision, cognition, and physical capability that, in turn, depend on the relative integrity of cerebral functioning. Fairly common medical conditions such as dementia, stroke, and seizures affect the brain, and may therefore compromise safe driving. Evidence of unsafe or impaired driving in these diagnostic groups has been presented, but has also been subject to debate. Furthermore, legislation regarding license holding for people with different medical conditions varies widely across countries and states. Nonetheless, it is important, in the clinical context, to determine whether patients should drive, when their medical conditions may put them or other road-users at risk. When patients with dementia and post-stroke conditions are not evidently either fit or unfit to drive, assessments should ideally be carried out by multi-professional teams comprising physicians, neuropsychologists, and/or occupational therapists. Areas addressed should be visual functioning, cognition (with an examination of domains such as attention, speed, and visuospatial ability), and the ability to handle the vehicle. It is also necessary to consider additional factors such as medication use, the presence of co-morbidities and risk of recurrence of stroke, and the risk or speed of progression that makes it necessary to reexamine the patient at suitable intervals (in cases of dementia, at least on a yearly basis). Professionals should be aware of the fact that there is no perfect ‘golden standard’ against which to compare the outcome of the clinical examinations and that factors such as the occurrence of adverse traffic events or the compensatory potential of the individual patient, based on insight and/or premorbid driving skill, should be taken into consideration. Losing consciousness while driving constitutes a considerable traffic hazard, but there is no clear-cut evidence that drivers with epilepsy or seizures are over-represented in motor vehicle crashes. Legislators in different countries have differing approaches to the granting of driving privileges to patients who have had seizures and the required duration of a seizure-free period before driving can be resumed can vary considerably on grounds that do not appear to be scientifically based.