What do the national guidelines tell us?

Answer: There are two sets of national guidelines:

3rd Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD3) guidelines from 2007: Item 25 (page 18) of the document deals with driving a motor vehicle.

Canadian Medical Association (CMA) guidelines: Determining Medical Fitness to Operate a Motor Vehicle 7th Edition 2006 Section 7.3.3

The following table summarizes the recommendations and shows where the two guidelines overlap and differ:

CCCDTD3 CMA
Discuss driving as part of routine dementia assessment
Driving cessation is an inevitable consequence of dementia therefore driving should be discussed early in the clinical course of the disease. Driving cessation is an inevitable consequence of dementia therefore driving should be discussed early in the clinical course of the disease
No single pen and paper test or combination of tests has sufficient sensitivity or specificity to be used as a single determinant of driving ability No single pen and paper test has sufficient sensitivity or specificity to be used as a single determinant of driving ability
Abnormalities on the MMSE, Trails B or clock drawing test should trigger further in-depth assessment of driving ability Abnormalities on the MMSE, Trails B or clock drawing test should trigger further in-depth assessment of driving ability
Driving is contra-indicated in persons who for cognitive reasons have an inability to perform multiple instrumental activities of daily living (IADLs) or any basic activity of daily living (BADL) Moderate to severe dementia is a contra-indication to driving

Moderate dementia means inability to perform two or more instrumental activities of daily living (IADLs) or any basic activity of daily living (BADL)

In mild dementia: use professional based off and on-road testing every 6 – 12 months In mild dementia: use on-road testing every 6 – 12 months
Compensatory strategies (eg not driving on the highway, at night, or alone) are not appropriate for those deemed unsafe to drive