CLINICIAN’S CORNER CARE OF THE AGING PATIENT FROM EVIDENCE TO ACTION TheOlderAdultDriverWithCognitiveImpairment “It’s a Very Frustrating Life”

The Patient’s Story Mr W is a 92-year-old retired college professor who lives at home with his wife in an upscale suburban neighborhood that offers little public transportation. Although his wife can operate a motor vehicle, she prefers that Mr W drive. Mr W has obstructive sleep apnea, hypertension treated with lifestyle modification, treated vitamin B12 deficiency, mild chronic anemia, restless legs syndrome, osteoporosis, edema, and a history of prostate cancer. His only medication is vitamin B12. About 8 years ago, the patient reported mild forgetfulness to his geriatrician, Dr D. In 2004, Mr W reported that he had lost his way while driving to a familiar museum, had difficulty recalling details of his personal art collection, and had fallen a few times. His score on the Mini-Mental State Examination (MMSE) was 30/30. In January 2009, he reported that his memory loss troubled him and that driving had become more difficult. He had no driving violations, and neither he nor his wife reported unsafe driving practices. He could independently perform all basic activities of daily living (ADL) and instrumental ADL, and he could walk a quarter mile without difficulty. His MMSE score was now 29/30. Neuropsychological testing was consistent with mild cognitive impairment (MCI). Dr D thought the MCI might be due to early Alzheimer disease and recommended assessment at a driving evaluation clinic. Mr W, his wife, and Dr D were interviewed by a Care of the Aging Patient series editor in May 2009.