Introduction: With rise of dementia globally, increasing clinical competence to manage cognitively impaired drivers requires attention. Cogntively impaired drivers are 2-8 times at higher risk of crashes than healthy drivers. Both doctors and driver-assessor therapists play a critical role to review fitness-to-drive of these drivers. Considerable driving research exists in Western countries compared to little from Asian countries.
Objectives: This study aimed to report on available guidelines for managing cognitively impaired drivers, with potential translation into Asia.
Methods: A scoping review across 6 databases was conducted to identify relevant guidelines to manage cognitively impaired drivers. Three authors independently screened the titles and abstracts of 4850 English publications (2018-2022), selected 92 studies for full-text review and identified 5 studies highlighting guidelines from US, Canada, UK, Ireland, Belgium, Australia and New Zealand. The latest versions of these guidelines were accessed online for comparative decriptive comparison.
Results: Ten guidelines from 7 countries: US (n=2), Canada (n=2), UK (n=2), Ireland, Belgium, Australia and New Zealand were reviewed. All guidelines support driving assessments and conditional licensing in non-professional drivers with dementia. Canada does not allow co-piloting and geographical rstricitions in condiional licenisng practice. Few guidelines provide indemnity for doctors reporting to licensing authorities. Communication about the impact of dementia on car insurance is rarely addressed. Most guidelines include evidence-based aproaches and provisions for drivers with mild cognitive impairment, and early discussion on driver retirement transition. A clinic-based functional screening toolbox and two clinical alogrithms (one with, and another without the Clinical Dementia Rating Scale) were identiifed as having universal application.
Conclusion: Useful evidence-based resources exist for Asian driver-assessor therapists to proactively engage with doctors to develop guidelines for cognitively impaired drivers.