Alzheimer and driving: when and how to stop safely

Table of contents

1. Why Alzheimer and driving are incompatible

2. Warning signs: when to worry

3. Medical assessment: tests and decision

4. How to announce the cessation of driving

5. Administrative and legal procedures

6. Mobility alternatives: preserving autonomy

Why Alzheimer and driving are incompatible {#incompatibilite}

The required capabilities for driving

Driving = complex activity requiring:

1. Sustained attention

• Monitoring road, mirrors, pedestrians simultaneously

2. Executive functions

• Planning route
• Anticipating dangers
• Making quick decisions

3. Memory

• Remembering the highway code
• Retaining route
• Procedural memory (automatic gestures)

4. Spatial orientation

• Knowing where you are, where you are going
• Recognizing familiar roads

5. Reactivity

• Braking quickly (reaction time)

6. Motor coordination

• Steering wheel + pedals + gear lever

What Alzheimer destroys

All these capabilities are progressively impaired.

Mild stage:

• Disorientation (gets lost)
• Forgetfulness (forgets where he was going)
• Slowing down (slow reactions)

Moderate stage:

• Total confusion (no longer knows how to drive)
• Apraxia (forgets gestures - clutch, brakes)
• Imminent danger

Consequence: Driving with Alzheimer = DANGER.

Alarming statistics

• Accident risk x2.5 (vs healthy drivers of the same age)
• 40% of mild Alzheimer’s have accidents in the year following diagnosis
• Accidents often serious (confusion → poor decisions)

Legal responsibility: If an accident with a victim → Criminal charges (endangering others).

Warning signs: when to worry {#signes}

Obvious signs (immediate cessation)

🚨 IMMINENT DANGER:

1. Gets lost on familiar routes

2. No longer respects traffic lights, stops, priorities

3. Inappropriate speed (too slow or too fast)

4. Repeated accidents (even minor ones)

5. Confusions (brake/accelerator)

6. Forgets destination en route

7. Other users frequently honk

8. Family refuses to ride with him/her

→ IMMEDIATE cessation of driving.

Early signs (increased monitoring)

⚠️ Increased vigilance:

1. Hesitations (intersections, maneuvers)

2. Scratches, minor bumps (doors, mirrors)

3. Forgets code (no longer knows priority to the right)

4. Avoids driving at night, rain (awareness of difficulties)

5. Family is worried (even if no accident)

6. Parking difficulties (missed maneuvers)

7. Quick fatigue at the wheel

8. Passenger comments: "Watch out!", "Brake!"

→ Medical evaluation + Monitoring.

Family self-assessment grid

Answer yes/no:

| Situation | Yes | No |

|-----------|-----|-----|

| Has gotten lost at least once | ☐ | ☐ |

| Accidents/bumps (last 6 months) | ☐ | ☐ |

| No longer respects traffic code | ☐ | ☐ |

| Confusion (brakes, gears) | ☐ | ☐ |

| Family refuses to ride with | ☐ | ☐ |

| Speed too slow (causing traffic issues) | ☐ | ☐ |

| Slow reactions (honks behind) | ☐ | ☐ |

If 1 YES → Consult a doctor urgently.

If 2+ YES → Immediate cessation of driving.

Medical assessment: tests and decision {#evaluation}

Consultation with the primary care physician

First step: General practitioner.

Assessment:

Possible decisions:

Important: The doctor MAY (but is not obliged to) report to the prefecture if he/she deems it dangerous.

Driving assessment center

Complete evaluation:

1. In-depth cognitive tests

2. Simulator tests

3. Real road test

Result:

Procedures if cessation is decided

Doctor can:

Doctor is NOT obliged to report (unless refusal to stop + danger).

How to announce the cessation of driving {#annonce}

Preparing the announcement

Timing:

Actors:

Location: Home, calm.

Communication techniques

1. Involve medical authority

"The doctor says you can no longer drive for your safety."

Advantage: Responsibility = doctor (not family).

Less conflict (family = not "the bad guys").

2. Focus on safety (not capabilities)

❌ To avoid:

"You are no longer capable of driving."

✅ To say:

"It’s dangerous for you, we want to protect you."

Frame = protection, not judgment.

3. Value cooperation

"You have always been careful. Stopping now is being responsible."

4. Offer alternatives immediately

"We will accompany you, there are solutions."

Do not leave in a void (loss without compensation).

Possible reactions and management

Reaction 1: Anger, refusal

"You want to take my freedom! I drive very well!"

Response:

Reaction 2: Sadness, tears

Response:

Reaction 3: Acceptance

Rare, but possible (sometimes relieved - knew deep down).

Response:

Workarounds (if total refusal)

1. "Hide" the keys

Pretext:

Not very ethical, but sometimes necessary (safety comes first).

2. Neutralize the vehicle

Pretext: Breakdown.

3. Sell the vehicle

If persistent refusal:

Safety > Emotional comfort.

Administrative and legal procedures {#demarches}

1. Administrative suspension of license

Who decides?

Prefect (upon reporting by doctor or family).

Procedure:

Delay: 2-3 months.

2. Return of license (optional)

Not obliged to physically return (except for administrative suspension).

But advised: Prevents anyone from driving illegally.

Where to return? Prefecture (against receipt).

3. Car insurance

Inform insurer:

Savings: Insurance premium.

4. Registration certificate

Keep vehicle (passenger use):

Sell vehicle:

5. Legal responsibility if accident

If driving DESPITE prohibition:

Prevent at all costs.

Mobility alternatives: preserving autonomy {#alternatives}

Transport by family/friends

Organize schedule:

Ritualize: Weekly outing (walk, coffee).

Conventional taxis

Taxis + inclusion mobility card (CMI):

Request CMI: MDPH (Departmental House for Disabled Persons).

Adapted transport

Municipal services:

Inquire: Town hall, CCAS.

On-demand transport (TAD)

Rural areas:

Home delivery

Shopping:

Pharmacy:

Meals:

Electric bike, scooter (only mild stage)

If capabilities preserved:

But supervision: Risk of getting lost.

Volunteer accompaniment

Associations:

Outings, shopping, companionship.

EDITH to stimulate orientation

Spatial orientation games:

Managing the grief of driving

For the person with Alzheimer’s

Huge symbolic loss:

Grief phases:

1. Denial ("I drive very well")

2. Anger ("You treat me like a child")

3. Bargaining ("Just short trips")

4. Sadness

5. Acceptance (gradual)

Accompany each phase.

For the family

Guilt: "I’m taking away his freedom."

Response: Safety comes first. You are protecting his life (and that of others).

Fatigue: Organizing transport (time-consuming).

Response: Share with family, friends, services. Ask for help.

Testimonials

Claire, 60 years old (father with mild Alzheimer’s)

"My father drove for 50 years. Telling him to stop = impossible mission. The doctor had an evaluation at the driving center. Verdict: unfit. My father cried, but accepted (medical authority). We organized: my brothers and I take him everywhere. He no longer talks about the car. It took 6 months, but it’s done."

Jean, 72 years old (wife with moderate Alzheimer’s)

"My wife got lost 3 times in 1 month. I sold the car (without telling her). She asked twice, then forgot. Not proud of my lie, but it was that or a fatal accident. Safety above all."

Conclusion: Safety above all

Stopping driving with Alzheimer’s is painful but necessary. It is an act of love: to protect the person, to protect others. Anticipate, assess, announce with empathy, offer alternatives: these are the keys to a successful transition.

The key steps:

1. ✅ Identify warning signs

2. ✅ Objective medical assessment

3. ✅ Empathetic announcement (involve doctor)

4. ✅ Administrative procedures (license, insurance)

5. ✅ Mobility alternatives (taxis, family, adapted transport)

6. ✅ Accompany the grief (patience, understanding)

Your loved one has the right to live safely. You have the duty to help them do so. Even if it’s difficult.

DYNSEO resources to manage this transition:

Stopping driving is giving up a freedom. But it is gaining safety. Choose life.