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    Dementia Symptoms & Caregiver Strategies: DMV Procedures for Drivers with Cognitive Difficulties

    California’s Health & Safety Code requires physicians to submit a confidential report to the county health department when an individual is diagnosed as having cognitive impairments that may affect a person’s ability to operate a motor vehicle. This information is forwarded to the Department of Motor Vehicles (DMV). If the physician’s report indicates that an individual has moderate or severe difficulty processing information, that individual will no longer be permitted to operate a motor vehicle. The DMV has determined that drivers with memory loss in the mild stages may have the cognitive functions necessary to continue driving safely. DMV requires re-examination for all individuals reported to have mild dementia.

    Warning Signs for Drivers with Cognitive Difficulties
    A diagnosis of mild cognitive impairment alone is not an automatic reason to stop driving. You can use this list as an objective way to monitor any changes in driving skills over time.

    1. Decrease in confidence while driving
    2. Difficulty turning to see when backing up
    3. Other drivers often honk horns
    4. Difficulty parking within a defined space
    5. Hitting curbs
    6. Scrapes or dents on the car, mailbox or garage
    7. Trouble navigating turns
    8. Moving into wrong lane
    9. Ticketed moving violations or warnings
    10. Getting lost in familiar places
    11.  Car accident
    12.  Failure to stop at stop sign or red light
    13.  Confusing the gas and brake pedals (person should stop driving immediately)
    The California DMV follows specific procedures when a medical report is received:
    1. The individual is contacted by letter and sent a "Driver Medical Evaluation" form to authorize his/her primary physician to submit medical information about the status of the dementia to DMV.
    2. A Driver Safety hearing officer reviews the medical form. If the documentation reveals that the impairment is in the mild stage, the person with cognitive impairment is scheduled for a re-examination with DMV. If the individual has moderate or severe memory loss, driving privileges will be revoked. If he or she fails to submit medical documentation within the requested time frame, all driving privileges will be suspended.
    3. A re-examination is completed, involving three phases: a visual test, a written test, and an interview.
      • Visual Test: All drivers must have corrected visual acuity of better than 20/200 in the better eye without the use of a bioptic telescope (an optical device attached to eyeglasses to increase focus).
      • Written Test: The individual is given the standard DMV written examination designed to test a person's knowledge of the road. The written test allows DMV to determine not only the individual's knowledge of driving laws, but more importantly, his or her mental competency and cognitive skills.
      • Interview: The in-person interview focuses on the medical documentation as well as the driver's ability to coherently answer questions about his or her health, medical treatment, driving record, need to drive, daily routine, need for assistance with daily activities, etc. Persons who do well up to this point are then given a driving test. Those who do poorly on the visual, written, or verbal tests may have their driving privilege suspended or revoked.
    4. The driving test is designed to test driving skills that might be affected by mild cognitive impairment. For instance, the first thing observed is whether the individual can find his/her car. Then, the examiner gives a series of commands, rather than one direction at a time (for example, "Please drive to the corner, turn left and turn right at the first street"). The test generally lasts longer than the ordinary driver's test in order to gauge whether or not fatigue is a problem.
    What actions can be taken after the reexamination?
    After your reexamination, the DMV hearing officer may:
    • Determine that no condition exists that makes the person unsafe to drive.
    • Restrict his or her driving privilege.
    • Suspend or revoke his or her driving privilege.
    • Reexamine the individual’s driving ability at a future date.
    • Tell the person that they must comply with his or her medical regimen and report any changes to DMV.
    • Tell the person that they must submit annual medical reports to DMV on specified dates.
    • Issue the individual a limited term driver license. A limited term driver license is one that is issued for a term shorter than a regular term license. This type of license requires the person to return to DMV for more frequent reevaluation and/or testing.
    An appeals process is available if the individual or family wishes to contest the suspension or revocation of the driver’s license. At the hearing the individual must present evidence, such as new medical information, to prove that the cognitive impairment does not impair his or her ability to safely operate a motor vehicle.

    Rest assured that the Brain Health Center never sends any confidential or chart information to the DMV or anyone else that is not associated with your care. We only recommend either a license suspension or safety evaluation based on the results of a cognitive evaluation.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: