Enhancing guidelines for managing cognitively impaired drivers: Insights from Western evidence for Asian adaptation

Abstract

Introduction: The global incidence of dementia is increasing, and cognitively impaired drivers are at a higher risk of crashes compared to healthy drivers. Doctors face challenges in assessing these at-risk drivers, with questionable adherence to existing guidelines. This study aimed to review and compare guidelines for managing cognitively impaired drivers from various countries. Method: A scoping review was conducted to identify relevant guidelines, which were then descriptively compared with Singapore’s guideline. Results: Eleven guidelines from 8 countries: US (n=2), Canada (n=2), UK (n=2), Ireland, Belgium, Australia, New Zealand and Singapore were reviewed. All guidelines support driving assessments and conditional licensing in ordinary (i.e. non-professional) drivers with dementia. Canada stands out for not allowing co-piloting and geographical restrictions in conditional licensing practice. Few guidelines provide indemnity for doctors reporting to licensing authorities, and communication about the impact of dementia on car insurance is rarely addressed. Most Western guidelines include evidence-based approaches, provisions for drivers with mild cognitive impairment and early discussions on transitioning from driving. A clinic-based functional screening toolbox and 2 clinical algorithms (1 with and 1 without the Clinical Dementia Rating scale) were identified as having universal applicability. Singapore’s guideline, by comparison, is outdated and lacks both developmental rigour and guidance on managing mild cognitive impairment and transitioning drivers out of driving. Conclusion: Comprehensive, evidence-based guidelines from Western countries provide valuable resources that can help Singapore design or update its guidelines.