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Driving and our aging population
CMAJ 2000;163(9):1131[Letters in PDF]


In response to: A.M. Byszewski
Anna Byszewski and William Dalziel call for a scientifically sound and well-validated assessment tool to screen drivers for dangerous cognitive deficits. We echo that call. We acknowledge that the Mini-Mental State Examination has been criticized as a tool to effectively identify individuals who perform poorly on a road test1 and that widespread consensus is lacking regarding the use of cut-off scores on this examination.2

However, it is impractical to suggest to physicians that all patients with suspected cognitive difficulty be referred for a standardized on-road, or even simulated, evaluation. Doctors in clinical practice need a screening tool to assist decision-making. Despite the above-mentioned concerns, the Mini-Mental State Examination has been shown to correlate with on-road driving test results,3 and poor performance on parts of the Mini-Mental State Examination correlates with the risk of adverse driving events.4 Decisions concerning driving aptitude must often be made on uncertain grounds. It should be noted that the statement referenced by Byszewski and Dalziel is a direct quotation from the standards found in the National Safety Code5 developed by the medical consultants for the provincial and territorial driver licensing authorities. Extracted from the context of the National Safety Code quotation, the statement quoted by Byszewski and Dalziel on the Mini-Mental State Examination test scores reads as a hard-and-fast rule; the CMA guide6 specifically mentions that physicians should consider the impact of education and language on test results.

As noted in the CMA guide,6 liability can result when physicians fail to report potentially medically unfit patients if these patients subsequently have an accident and cause harm to others. The Mini-Mental State Examination is one tool for identifying potential unfitness to drive. Physicians, especially where there is a mandatory reporting system, should err on the side of caution and report potentially medically unfit drivers.6 A physician could deem a patient potentially unfit even without the administration of the Mini-Mental State Examination. It is only one tool to assist physicians in determining medical fitness to drive.

David W. Irving
Chair, Project Advisory Group
Determining Medical Fitness to Drive:
   a Guide for Physicians

Edmonton, Alta.


References

    1.   Dobbs AR. Evaluating the driving competence of dementia patients. Alzheimer Dis Assoc Disord 1997;11(Suppl 1):8-12. [MEDLINE]
    2.   Johansson K, Lundberg C. The 1994 international consensus conference on dementia and driving: a brief report. Alzheimer Dis Assoc Disord 1997;11(Suppl 1):62-9. [MEDLINE]
    3.   Fox GK, Bowden SC, Bashford GM, Smith DS. Alzheimer's disease and driving: prediction and assessment of driving performance. J Am Geriatr Soc 1997;45:949-53. [MEDLINE]
    4.   Marottoli RA, Cooney LM, Wagner DR, Doucette J, Tinetti ME. Predictors of automobile crashes and moving violations among elderly drivers. Ann Intern Med 1994;121:842-6. [MEDLINE]
    5.   Canadian Council of Motor Transport Administrators. National safety code medical standards. Ottawa; The Council; 1999.
    6.   Canadian Medical Association. Determining medical fitness to drive: a guide for physicians. Ottawa: The Association; 2000.

 

 

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