Dementia and driving: how to know when to limit or stop
How families can spot changes, plan ahead and handle the day driving must end
Dementia changes the brain skills that driving depends on. Memory, attention, judgment and the ability to react quickly all slowly decline. Alzheimer’s disease is the most common type, but there are others.
The hard truth is simple. Some people can drive safely for a while after a diagnosis. But the disease keeps progressing. The American Academy of Neurology says nearly all people with dementia will eventually have to give up driving [1]. This guide explains how to tell when, and how to make the change with care.
What the research says
In 2010, the American Academy of Neurology reviewed the science on driving and dementia. Its guideline is still the main reference doctors use [1]. Here is what it found.
Some people with mild dementia can still pass a road test. Studies found that as many as 76 percent of people with mild dementia could pass an on road driving test [1]. So a diagnosis alone does not settle the question.
Severity matters. Doctors use a scale called the Clinical Dementia Rating. People who score 1 or higher, meaning mild dementia or worse, are at higher risk. The guideline says they should be discouraged from driving [2].
The person’s own opinion is not reliable. The guideline found strong evidence that a patient’s self rating of “safe” is not useful [1]. People with dementia often do not notice their own mistakes.
The family’s opinion matters. A caregiver who says the driving is “marginal” or “unsafe” is a useful warning sign [1].
Other red flags. A history of crashes or tickets points to higher risk. So do driving fewer miles, avoiding certain situations, aggressive or impulsive behavior and a low score on a common memory test [1].
Check again often. Because dementia gets worse, doctors are advised to reassess driving about every six months [2].
Warning signs to watch for
Watch for these changes. Write down what you see and when.
- Getting lost on familiar routes or forgetting where they were going
- Taking a long time to decide at intersections or four way stops
- Missing traffic signs or signals
- Confusing the gas and brake pedals
- Hitting curbs or drifting across lanes
- Getting angry or confused while driving
- New dents or scrapes they cannot explain
- Needing a passenger to call out turns or traffic
Warning: If the person has gotten lost while driving, made a dangerous mistake or confused the pedals, they should stop driving now. Contact their doctor right away.
Plan ahead while they can help decide
The best time to talk about driving is soon after the diagnosis, while the person can still share in the decision. Many families make a written “driving agreement.” It says who will decide when driving should end and how that will happen. It also says who will help with rides.
When people help set the rules early, the final step feels less like a loss of control. It becomes a plan they agreed to.
Start with limits that lower risk:
- Drive only on short, familiar routes
- No driving at night, in bad weather or on highways
- Always have a passenger along
- No driving with grandchildren in the car
Get a professional opinion
If you are unsure, ask the person’s doctor for a referral to a comprehensive driving evaluation. A driver rehabilitation specialist, often an occupational therapist, tests vision, thinking and physical skills, then watches the person drive in a car with a passenger side brake.
An outside expert can say what a family member cannot. Results also give everyone a shared set of facts.
Know your state's rules
States handle dementia and driving differently. A 2024 study in JAMA Network Open identified four states that require clinicians to report a dementia diagnosis to the driver licensing agency: California, Delaware, Oregon and Pennsylvania [3]. In California, for example, doctors must report Alzheimer’s disease and related disorders to the local health officer, who passes the report to the DMV [6].
The same study found something worth knowing. Primary care clinicians in those states were more likely to miss a dementia diagnosis. Their adjusted underdiagnosis rate was 12.4 percent, compared with 7.7 percent in states with no clear rule [3]. The study shows a link, not proof of cause. But it suggests some families and doctors may avoid the diagnosis because of the license.
That is a mistake. An early diagnosis opens the door to treatment, legal and money planning, and a safe driving plan. Losing the license is not a reason to avoid the doctor.
In every state, family members can ask the driver licensing agency to review a driver. The agency may order tests.
When the person will not stop
This is often the hardest part. The person may not remember agreeing to stop, or may not believe there is a problem. Arguing usually does not help. Try these steps, one at a time:
- Ask the doctor to write it down. A written “do not drive” order from a doctor carries weight.
- Let the state decide. Request a driver review. A license decision from the state is not the family’s fault.
- Remove the temptation. Keep keys out of sight. Park the car somewhere else, or sell it.
- Ask a mechanic for help. A mechanic can make the car hard to start. Tell the person it is “in the shop.”
- Fill the gap fast. Line up rides right away. Boredom and isolation make people want to drive.
The Alzheimer’s Association and the National Institute on Aging both offer guides for families on this step [4, 5].
Care for the feelings, too
Losing the right to drive is a real loss. The person may feel angry, sad or embarrassed. Let them grieve. Keep their routines going: the barber, the coffee shop, the weekly card game. The goal is to protect the person’s life, not just the roads.
Checklist: dementia driving plan
Checklist from Safety Behind the Wheel Foundation
- We talked about driving soon after the diagnosis
- We wrote down who will decide when driving ends
- We agreed on limits for now (daytime, short trips, passenger along)
- We set a date to recheck driving in six months
- We know how to request a driving evaluation
- We know our state’s process for a driver review
- We have a ride plan for doctor visits, shopping and social time
Frequently asked questions
Can someone with mild cognitive impairment drive?
Often, yes, for a time. Mild cognitive impairment is less severe than dementia. But it can progress. Watch for the same warning signs and recheck driving regularly.
Will car insurance cover a crash if the driver has dementia?
Policies differ. An insurer may look at whether the driver had a valid license and whether the family knew about the risk. Ask your insurer and an attorney if you have concerns.
What if the person drives off alone and gets lost?
Call 911 right away and give a description of the person and the car. People with dementia who drive can travel far and end up in danger. Taking away access to the car prevents this.
Related articles
Sources and further reading
- 1Iverson DJ, Gronseth GS, Reger MA, et al. “Practice Parameter update: Evaluation and management of driving risk in dementia.” Neurology, 2010. pmc.ncbi.nlm.nih.gov/articles/PMC2860481
- 2American Academy of Family Physicians. “AAN Updates Guidelines on Evaluating Driving Risk in Patients with Dementia.” American Family Physician, 2010. aafp.org/afp/2010/1101/p1144
- 3Jun H, Liu Y, Chen E, Becker A, Mattke S. “State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis.” JAMA Network Open, 2024. jamanetwork.com/…/2818090
- 4National Institute on Aging. “Driving Safety and Alzheimer’s Disease.” nia.nih.gov/…/driving-safety-and-alzheime…
- 5Alzheimer’s Association. “Dementia and Driving.” alz.org/…/dementia-driving
- 6Family Caregiver Alliance. “Dementia, Driving, and California State Law.” caregiver.org/…/dementia-driving-and-califo…
This article reflects the safety priorities of dementia caregiving and older driver safety. It is general education, not medical or legal advice. Check official sources and the person’s doctor for guidance. Reviewed November 2026.
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