The patient with Alzheimer, his caregiver, and driving
Alzheimer’s disease is due to a degenerative process, associated with significant neuronal loss in multiple brain areas, and marked brain atrophy.
In Spain, there are approximately 800,000 patients with this disease.
The most significant initial symptom is memory loss, and in the first phase no awakening disorders occur.
The clinical features that characterize the patient with Alzheimer, such as loss of memory, speech, calculation, visual and spatial abilities, or the ability to solve problems, reflect a fast loss of neurons.
This affects particularly some brain areas, including the hippocampus, the limbic system, and strategic segments of the temporal, frontal, and parietal cortex.
Dementia progresses constantly, reaching an advanced situation in 2-3 years.
The caregivers of these patients frequently suffer an extreme personal overload, that is evidenced with sleep disturbances, depression, and several psychological disorders.
The difficulty to identify in its early phase the patient with Alzheimer since the manifestations are considered to be normal signs of aging, together with the fact that elderly people are afraid to suffer the disease and go late to the clinic, making that the medical diagnosis is difficult at the start of Alzheimer.
These problems cause that, in Spain, 40% of the patients with Alzheimer are not diagnosed nor treated.
Among the patients who finally first go to a medical office, 49% already suffer mild Alzheimer, 41% suffer it moderate, and 10% serious.
Biological signs of suffering Alzheimer have been found in necropsies made in elderly drivers, though they did not have marked clinical signs yet.
With a greater investigation of those “organic signs”, the renewal of driving licenses could be better defined at some ages.
A study of accidents in Sweden and Finland reported that a third of drivers between 65 to 90 years of age who died in accidents, had brain lesions related to Alzheimer’s disease.
Furthermore, other 20% had injuries that could suggest an early stage of the disease.
Although there is no definitive cure for Alzheimer, drug therapies are currently available that reduce the progression of the disease and are able to improve the quality of life of the patients and their caregivers.
Thus, four drugs are currently marketed: donepezil, rivastigmine, galantamine, and memantine.
Cholinesterase inhibitors have proven to be effective in case of delirium and hallucinations, symptoms of Alzheimer’s disease, while they succeed in diminishing the progression of the disease.
In addition, therapeutic options are available that can stimulate cognitive function in the patients.
Recommendations to the caregivers of the patients
- The caregivers of patients with dementia can be drivers at risk for the tiredness, isolation, and stress to which they are subject.
- The caregivers should relate to other caregivers to discharge their emotions and exchange useful information, not only for the care of the patient, but also to release from the psychological activity of the care.
- Insomnia of the caregiver, based on the lack of night rest for monitoring the patient, is a problem with clear impact for traffic, either as driver, either as pedestrian, due to the associated daytime somnolence.
- Depression, anxiety disorders, fatigue, reduced work performance, etc., are some of the triggering symptoms of disease, suffered by the relatives who support the burden of the care of a patient with Alzheimer or another dementia associated with the old age.
- The driving caregiver enjoys a period of freedom that can be beneficial, but also dangerous for the relaxation in compliance with the rules to a lower attention and concentration, that these tired people show when driving.
- The personal physical and psychical workload of the caregiver of the patient with dementia can make him less tolerant with the setting, and vulnerable in decision-making in case of an unexpected event.
- They should be advised to drive accompanied, and if they are tired, they should better not drive and another people should assume the responsible of driving.