In late September 2023, Parkinson and Movement Disorder Alliance (PMD Alliance) hosted Dr. Anthony LoGalbo for a presentation on driving with Parkinson’s disease (PD). PD is a progressive disease, and both motor and non-motor symptoms will affect people’s ability to drive. Someone with PD may need an evaluation every year. Driving is often a safety concern – both physically and financially. Driving represents independence and autonomy. Dr. LoGalbo assured attendees that not all people with PD need to stop driving right away. Accommodations and workarounds may be used, and when someone with PD does need to stop driving, there are other options for transportation.
Dr. LoGalbo cited a recent study of in-car driving assessment data that found that within the same age group, 0-24% of those without PD failed their driving assessment, while 30-56% of people with PD failed. According to the same study, people with PD checked their rear-view mirrors less often.
A recording of the webinar is available on the PMD Alliance YouTube channel
You can find resources for driving with PD on the Stanford Parkinson’s website:
Below are my notes on the webinar.
“PD and Driving: How to Steer Clear of Danger”
Speaker: Anthony LoGalbo, PhD, Director of Neuropsychology, Health First Memory Disorders Clinic
Webinar Host: PMD Alliance
Webinar Date: September 28, 2023
Summary by: Jordan Dagan, Stanford Parkinson’s Community Outreach
Dr. Anthony LoGalbo specializes in assessing those with cognitive impairment for driving safety, and working with them to make a plan for safer transportation around their community. He’s worked with people with Parkinson’s disease (PD), traumatic brain injury, and dementia.
Dr. LoGalbo does not administer on-road driving assessments, but uses data collected by researchers who do to advise his clients. He cited a recent study, which reviewed in-car driving assessment data and found that within the same age group, 0-24% of those without PD failed their driving assessment, while 30-56% of people with PD failed. According to the same study, people with PD checked their rear-view mirrors less often.
RECOGNIZING WHAT SKILLS AND RISKS DRIVING REQUIRES
Many of us have been driving for many years, and may take for granted the variety of complex tasks involved in driving even a simple route or short distance. Keep in mind that the following list doesn’t include factors specific to PD!
- Switching attention between multiple factors.
- Judging speed and distance of your vehicle and other vehicles, motorcycles, bicycles and pedestrians.
- Maintaining position in one lane.
- Shifting between gas and brake, at appropriate times, with appropriate pressure.
- Judging when to turn, and using turn signals.
- Judging distance and “where corners are” when parking.
- Checking blind spots and rear view mirrors.
- Navigation, including using GPS technology, and following a series of instructions.
- Merging into and out of traffic, and switching lanes.
- Coping with distractions from both inside and outside the car.
- Making quick decisions, and having fast responses to unexpected events.
- Communicating with passengers.
- Communicating with law enforcement or emergency personnel if there’s an accident.
Age-related changes, independent of PD, will affect all of us. These include changes to vision and hearing, slowed reflexes, and a higher chance of injury or death if we’re involved in a crash. If someone with PD is at risk of injury from falling while walking, the injuries they might sustain from being in a vehicle crash could be much more severe.
Dr. LoGalbo said he wants people to consider that the dangers of driving aren’t only physical, but financial as well. The person with PD may have to pay tickets and fines, or be called into court if they are sued for damages. In a vehicle accident lawsuit, the defendant’s ability to drive is called into question. The person with a cognitive or physical impairment may be deemed financially responsible for the other person’s medical or car repair costs, even if their driving was not the cause of the crash. Even if nobody was injured, the cost of repairs to your car, or someone else’s, may add up quickly.
PARKINSON’S EFFECT ON DRIVING
Dr. LoGalbo described some of the classic motor and non-motor symptoms of PD that are likely to impact people’s ability to drive.
- Tremor may affect ability to turn the steering wheel, and maintain lane position.
- Rigidity and slowness may prevent fast response times to unexpected events and/or sudden motion on the road.
- Rigidity and slowness may prevent easy movement of someone’s leg and foot between gas and brake, as well as the pressure someone puts on the pedals.
- Attention maintenance and shifting are often affected by PD.
- Changes to depth perception will affect someone’s ability to judge speed and distance, and their ability to avoid obstacles.
Dr. LoGalbo noted that changes in depth perception make driving in parking lots and parking the car especially difficult. Even at low speeds, accidents can happen! This contributes to the financial risk of driving. If your car is damaged by bumping into curbs and other obstacles, or if your car damages someone else’s, you may have to pay for repairs.
The side effects of medications people with PD may take (as well as others in later ages, even without PD) may also impact driving. Both prescribed or over the counter medications may cause sleepiness or drowsiness, dizziness, confusion and blurred vision. Discomfort from side effects may add a distraction.
COMPENSATING FOR PD WHILE DRIVING
Dr. LoGalbo emphasized that not everyone with PD must stop driving, and that there are ways to compensate in order to make driving with PD safer for you and for others on the road. The following is a list of possible accommodations that can make driving safer and less stressful for someone with PD:
- Reduce distractions, such as the radio and conversation with passengers.
- Be aware of what your challenges are, and how your medications affect you. Do NOT drive before you know how a new medication, or medication change, will affect you.
- Alter your driving times and routes so that you can minimize risk.
- Ex. Do not drive when you know your dopa medicine will wear off.
- Ex. Do not drive at night, when distance and speed are harder to judge.
- Use familiar routes, so you don’t have to split your attention between driving and navigation. If you do need to change routes, plan ahead of time, or pull over while you sort it out. Use GPS for navigation to reduce confusion and distraction.
- Reduce driving distances, to lessen the impact of fatigue.
- Avoid rush hour, or areas of heavy traffic.
- Avoid the freeway, where high speeds make slower reaction times especially hazardous.
- Have a passenger with you! They can help in many ways. This could even be an occupational therapist (more on driving assessments is below).
- Navigation help
- Situational awareness
- Parking assistance
- Help handling an accident or crisis
WHEN (AND HOW) TO STOP DRIVING
The care partners of someone with PD, and those who are their passengers while driving, may notice concerning aspects of their loved one’s driving. Some warning signs include:
- Scrapes, “dings,” or dents to the outside of the car.
- Near accidents when driving, such as “close shaves” or sudden swerves necessary to avoid a collision.
- Poor parking alignment.
- Rolling over curbs frequently.
- Stopping partially into crosswalks, past stop signs, or “over the line.”
- Recent tickets, or an increase in being ticketed or fined.
- Changes to your loved one’s driving habits, such as not driving at night.
- Changes to your loved one’s mood about driving, such as increased defensiveness, or anxiety when driving.
- Recent accidents, even if they were minor, or only caused vehicle damage.
When approaching your loved one about their driving, remain supportive and non-confrontational. Discuss their driving skills, not their age. It may be helpful to share that you know that their driving skill may be very good, but their disease progression is causing them trouble driving. Emphasize that you care about their safety, and the safety of others on the road. Consider pointing out both the medical and financial danger of getting in an accident.
There are many ways to find alternative transport, if you need to reduce your time driving, or stop driving entirely. Ask family and friends for rides! Many want to help, and won’t find it an inconvenience, especially if your ride is planned ahead of time. Use public transportation, or a ride service such as a taxi, Uber, or Lyft. There are often local shuttle or van services for seniors or those with disabilities.
Remember: Safety is the priority! Dr. LoGalbo knows driving is a way to maintain independence and autonomy, especially when diagnosed with Parkinson’s. However, you can’t enjoy independence if you’ve been injured or hospitalized in an accident. An accident or lawsuit may also mean financial danger, and can damage savings that could otherwise be used for well being, medical care, and quality of life.
PD is a progressive illness, and your capacity for driving will change over time. Do NOT wait until you’ve had an accident to make accommodations to your driving habits, or to stop driving if necessary. Driving is unpredictable. Don’t gamble with your safety, or the safety of your passengers, or the safety of others on the road.
QUESTIONS AND ANSWERS
Question: How do you handle talking to a loved one about driving safety?
Answer: Your loved one may not have considered the issue before. Approach the conversation gently, but do point out your concerns. The goal isn’t to immediately stop them from driving if they are able to compensate. They may be able to avoid risky situations by changing when and where they drive. Changing behavior is hard, and it helps to go gradually.
Question: Some states ask if you have a condition that may affect driving. Do people need to disclose their PD diagnosis?
Answer: Some states don’t require a driving evaluation after a certain age, but some states do. Dr. LoGalbo suggests disclosing to help protect yourself from legal trouble. Even if you are not at fault for the accident, your diagnosis may become known, and the person who ran into you can sue.
Question: If my loved one had a driving evaluation, does that help with the legality issues you mentioned?
Answer: Dr. LoGalbo cannot give legal advice, but said that a passed driving evaluation will probably help avoid legal trouble if your loved one is in an accident. However, results may change depending on how long ago the evaluation was. PD is a progressive disease, so your loved one may need an evaluation every year. In some places, on-road driving evaluation is not covered by insurance, and there is no guarantee your loved one will pass the evaluation. If your loved one fails the evaluation, they may have to stop driving entirely. In some states, a failed evaluation may be disclosed to the DMV.