Driving & FTD

Driving is a highly complex, cognitively demanding task that must be thoughtfully considered for any individual with cognitive or behavioral changes. For many people, driving represents autonomy and independence, so this is understandably a very sensitive and often difficult topic, but one that is critically important for safety.

Individuals with Frontotemporal degeneration (FTD) often experience changes in behavior, including reduced judgment, impulsiveness or a decline in executive function. On the road, this may present as a reduced ability to detect unsafe turns, the inability to quickly predict and respond to other drivers’ actions with a moment’s notice, or increased frequency of dangerous actions while driving. Other individuals may have difficulty interpreting spatial relationships in their environment, which increases the risk of getting lost and makes it more difficult to accurately judge where their car is in relationship to other cars, poles or buildings. People with motor symptoms related to FTD disorders may have slower response times when physically stepping on the brake pedal or turning the steering wheel. All of these neurological symptoms increase an individual’s risk of being involved in a motor vehicle accident and potentially injuring themselves or others. Your neurologist may recommend a formal driving evaluation with a rehabilitation center to confirm driving fitness, or they  may be required to file a report with the DMV is there is a concern for unsafe driving.

As a caregiver, although very difficult, it is important to watch for early warning signs of unsafe driving and address concerns as early as possible in your loved one’s FTD disease course. Warning signs  can include increased frustration or agitation while driving, increased frequency of getting lost, especially on familiar roads, or more “fender benders” or near-accidents. Proactive conversations can ease the transition to using alternative modes of transportation, such as ride shares, organizing with family or friends, or community shuttles when available. It is natural for the person with FTD to resist or be upset by this change; this is a significant change, and they  may not fully understand the risks associated with their symptoms. Consistent, reassuring, compassionate communication, paired with practical alternatives to maintain as much independence as possible, are crucial. If tensions continue, physically removing access to the keys or disabling the car may be necessary to manage this adjustment. We recommend working with your care team and social worker to brainstorm ways to address driving early and often to best prioritize your loved one’s safety and wellbeing.

For additional information, please read additional information from the Association for Frontotemporal Degeneration here.

~ Penn FTD Center Cognitive Neurology Nurse Practitioner Gillian Bradley, MSN, CRNP, RN