DMV SUSPENSION FOR DEMENTIA

Why does the DMV suspend a Driver License for Dementia?

The California Department of Motor Vehicles (DMV) is a prominent government agency empowered by the State Legislature to issue driver licenses to qualified drivers. What most people are not aware of is just how much power the DMV also possesses to suspend or revoke a person’s privilege to drive for a variety of reasons.  The DMV’s mandate is to protect public safety by ensuring that all drivers possess the Skill, the Knowledge and the Physical/Mental Fitness to drive.

Under the category of Physical/Mental Fitness to drive, the DMV will continuously monitor the health of all drivers to ensure there are no Physical or Mental Disorders that could affect one’s ability to drive.  If such a disorder were to come to the DMV’s attention, the Department can act to remove that person from the road until it can be established they are fit to drive.

Some of the more common disorders that would cause the DMV to suspend or revoke a person’s driving privilege are:

• Lapse of Consciousness or Control (whether driving or not)
• Epilepsy or Seizure Disorder
• Neuropathy in the hands or feet
• Brain tumors
• Cancer
• Cardiac or Cardio-vascular Disorders
• Kidney or Liver Disorders
• Sleep Apnea or other Sleep Disorders
• Diabetes
• Pulmonary Disorders
• Parkinson’s Disease or tremors
• Addiction or habitual use of drugs, medications, or alcohol
• Problems with vision
• Problems with hearing
• Migraine headaches
• Mental Health Disorders such Depression, Anxiety, Bipolar Disorder or Schizophrenia
• Autism
• Cerebral Palsy
• Multiple Sclerosis
• Amputations
• Side effects of surgery
• Side effects of prescription medication
• Effects from Failure to Take Medication as prescribed

In this chapter we discuss the DMV’s concern over a person’s ability to safely operate a motor vehicle if they suffer with Dementia, Alzheimer’s Disease or any form of Cognitive Decline.

Cognitive Decline:

As we age, it is common for us to experience mild issues with memory.  We can all struggle to recall dates or the names of people we once knew.  It’s even common to forget where we placed our car keys or what we had for dinner the night before.   This is often referred to as “normal age-related memory loss.”  It is generally benign and does not affect safe driving.

The problem with Cognitive Decline is that many of the symptoms of this natural phenomenon are  they mimic many of those symptoms occurring with Dementia or Alzheimer’s patients.  Even more problematic is the instance where a driver is evaluated by a Primary Care Physician with a specialty in Internal Medicine who doesn’t understand the difference between Cognitive Decline and Dementia.  All too often, overzealous physicians with little or no specialized training in issues of cognition make incorrect assessments of patients that bring them to the attention of the DMV.

The other problem is that DMV Hearing Officers and support staff are not physicians and have no specialized training in understanding and investigating physical/mental disorders.  So, the DMV must rely upon relevant evidence provided by others to make informed decisions.

As a general rule, the DMV will not sustain an action to suspend or revoke a driver license based upon issues of Cognitive Decline, provided it is mild and stable; but, nonetheless, the department will conduct an investigation before coming to that conclusion, and the driver license will likely be suspended while that investigation proceeds.

Dementia

Dementia is not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. Alzheimer’s disease is the most common type of dementia, however, there are several other forms.   Though dementia mostly affects older adults, it is not a part of normal aging.

Of those at least 65 years of age, there was an estimated 5.0 million adults with dementia in 2014 and is projected to be nearly 14 million by 2060.

Dementia is caused by damage to or loss of nerve cells and their connections in the brain. Depending on the area of the brain that is damaged, dementia can affect people differently and cause different symptoms.

Dementias are often grouped by what they have in common, such as the protein or proteins deposited in the brain or the part of the brain that’s affected. Some diseases look like dementias, such as those caused by a reaction to medications or vitamin deficiencies, and they might improve with treatment.

Progressive Dementias

The types of dementias that progress and are not reversible include:

Alzheimer’s disease. This is the most common cause of dementia.  Although not all causes of Alzheimer’s Disease are known, experts do know that a small percentage are related to mutations of three genes, which can be passed down from parent to child. While several genes are probably involved in Alzheimer’s Disease, one important gene that increases risk is apolipoprotein E4 (APOE).  Alzheimer’s disease patients have plaques and tangles in their brains. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein. It’s thought that these clumps damage healthy neurons and the fibers connecting them.

Vascular dementia. This type of dementia is caused by damage to the vessels that supply blood to your brain. Blood vessel problems can cause strokes or affect the brain in other ways, such as by damaging the fibers in the white matter of the brain.  The most common signs of vascular dementia include difficulties with problem-solving, slowed thinking, and loss of focus and organization. These tend to be more noticeable than memory loss.

Lewy body dementia. Lewy bodies are abnormal balloon-like clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer’s Disease, and Parkinson’s Disease. This is one of the more common types of progressive dementia.  Common signs and symptoms include acting out one’s dreams in sleep, seeing things that aren’t there (visual hallucinations), and problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and rigidity (parkinsonism).

Frontotemporal dementia. This is a group of diseases characterized by the breakdown of nerve cells and their connections in the frontal and temporal lobes of the brain. These are the areas generally associated with personality, behavior and language. Common symptoms affect behavior, personality, thinking, judgment, and language and movement.

Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of several causes, such as Alzheimer’s Disease, vascular dementia and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.

Dementia is not part of the normal aging process. Many older adults live their entire lives without developing dementia. Normal aging may include weakening muscles and bones, stiffening of arteries and vessels, and some age-related memory changes that may show as:

Some of the signs/symptoms of Dementia are:

• Memory Loss
• Attention problems
• Communication problems
• Reasoning, judgment, and problem solving
• Visual perception beyond typical age-related changes in vision

Signs that may point to dementia include:

• Getting lost in a familiar neighborhood
• Using unusual words to refer to familiar objects
• Forgetting the name of a close family member or friend
• Forgetting old memories
• Not being able to complete tasks independently

Dementia is an organic brain disorder that is characterized by impaired cognition which normally has a negative effect on memory and judgment.  As the disease progresses, patients will commonly experience problems with paranoia, and disturbances of higher cortical function.  Unfortunately, many people affected with this disorder will also experience changes in their personality and will be prone to inappropriate behavior.

Dementia is often a progressive disorder that will develop through stages of severity.  In assessing a driver’s ability to operate motor vehicles, the DMV will use a graduated series of stages to estimate the impact the disorder has on a person’s ability to drive:

Mild Cognitive Impairment

At this stage, the driver is basically able to care for their own needs.  This person is generally able to shop for themselves, live independently and care for their own personal hygiene. Memory issues begin to arise.

Moderate Cognitive Impairment

At this stage, the driver is experiencing greater difficulty with independent living and may require supervision.  Spatial awareness may be affected and reasoning may be impacted to a point that they are unable to cope with their environment.  Perception/reaction time may be delayed and memory deteriorates.

Severe Cognitive Impact

At this most advanced stage, the person is no longer able to care for their own safety or hygiene.  Continual supervision is necessary and the person may be incoherent or mute.

 How does Dementia affect safe driving?

Just because a person has been diagnosed with Dementia does not mean they automatically must stop driving.  30% of people who are diagnosed with this disorder are fully capable of safe driving.

Over a lifetime of driving, many people consider driving to be an automatic function.  The truth is; however, safe driving is actually a multi-faceted skill that requires quick reasoning and thought processing, combined with the need for good vision, hearing, and manual dexterity.  The need to perceive danger and the ability to react quickly is critical.  While safe driving may seem like a natural function to an experienced driver, it is actually a quite complex task.

A person diagnosed with Dementia may have difficulty with:

• Attention and Concentration: This is critical as the driver must be able to evaluate roadway conditions and be able to move between several different driving tasks.

• Visual Spatial Skills: This is critical as the driver must be able to discern depth and distance so they can appropriately judge the distance between vehicles as well as properly maintaining speed and lane position.

• Problem Solving Skills: This is critical as the driver must be able to analyze obstructions, diversions and obstacles present or appearing in the roadway.

• Judgement and Decision Making: This is critical as the driver must be able to interpret and anticipate the actions of other drivers or pedestrians.

• Perception/Reaction Time and Processing Skills: This is critical as the driver must be able to react quickly to an ever-changing environment.

• Anger Management: This is critical as it is common for drivers to encounter other rude or aggressive drivers and losing one’s temper is a sure-fire path to problems.

• Memory Issues: This is critical as the driver must recall routes to be travelled, how to change gears and activate turn signals; and the meaning of road signs.

Probably the hardest truth to reconcile is that Dementia is often a progressive disorder that will cause the deterioration of the driver’s ability over time.  The progression of the disease is different for all people, but eventually it will cause the effected person to lose their driving privilege.

How does the DMV define Dementia?

In fulfilling its obligation to protect Public Safety, the California Department of Motor Vehicles (DMV) will focus upon any person it suspects suffers with any Physical or Mental condition that can affect safe driving.  One of the most aggressively investigated issues is the driver who has been diagnosed with Dementia.  This is because these disorders can profoundly affect a person’s ability to safely operate a motor vehicle; and because the driver may have no clue as to the level at which they are impaired.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life and therefore, clearly affects one’s ability to drive.  Alzheimer’s disease is the most common and identified form of Dementia.

Dementia is not a specific disease. It is an overall term that describes a wide range of symptoms associated with a decline in memory or other cognitive skills severe enough that a person’s ability to deal with day-to-day life is impacted.  Alzheimer’s disease accounts for 60 to 80 percent of diagnosed Dementia.  Vascular Dementia normally occurs following a stroke and is the second most common form of Dementia.  There are several other forms of Dementia, some of which are reversible, such as vitamin deficiencies and problems with the thyroid gland.

Most forms of dementia are progressive, meaning that symptoms begin slowly and gradually worsen over time.  Different types of Dementia are associated with particular types of damage to brain cells.  For example, in Alzheimer’s disease, high levels of certain proteins inside and outside the brain cells make it difficult for the cells to remain healthy and to communicate with one another.  The region of the brain known as the Hippocampus is the center for learning and memory and is often the first region attacked by Alzheimer’s disease.  As a result, memory loss is one of its earliest symptoms.

The DMV’s working definition of Dementia is:

“Any chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.”

How does the DMV learn that a driver has Dementia?

Of all the California Government Agencies, the California Department of Motor Vehicles (DMV) is among the most interactive with the general public.  Every day, there are literally thousands of contacts between the public and the department for issues ranging from vehicle registrations to driver license applications.

Because there is so much information flowing back and forth between the DMV and the public, the department is very much “hardwired” into the very fabric of our society.  Additionally, various laws in the State of California mandate that certain information be forwarded to the DMV, even if individual drivers would prefer it not happen.

Even though a diagnosis with Dementia a profoundly private matter, it absolutely can affect the safety of the motoring public and therefore is a point of concern for the DMV.  There are a variety of means by which the DMV learns of such a diagnosis:

• Physicians or other medical professionals: 12% of states require physicians or surgeons to report individuals who are cognitively or medically impaired to the DMV (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania). In California, reporting by physician’s accounts for the vast majority of cases handled by the DMV.  This is a perfect example of our government inserting itself into what should be a private matter between a doctor and their patient.  Unfortunately, physicians and surgeons have no choice but to report such a diagnosis to the DMV.

Health & Safety Code Section 103900(a) determines:

“Every physician and surgeon shall report immediately to the local health officer in writing, the name, date of birth, and address of every patient at least 14 years of age or older whom the physician and surgeon has diagnosed as having a case of a disorder characterized by lapses of consciousness.”

• Law Enforcement Officers: In many cases, a driver with Dementia isn’t aware to the extent his driving is affected.  Because police officers are a “first line” contact with the motoring public, it is common for officers to detect symptoms of cognitive decline during contacts with drivers which are then reported to the DMV.
• Family, Friends or Caregivers: This group of people has the most direct contact with the affected driver and are very often the source of information to the DMV.  This can create difficulty within the family as they struggle with their desire to protect the independence of loved ones versus their desire to protect everyone from a disastrous accident.
• DMV employees:   If you drive a motor vehicle in California, contact with the DMV is inevitable.  At some point, all of us will have to enter a DMV Field Office to register a car or renew or license.  When we enter a DMV Field Office, we step into their world and are subject to their observations and assessments.  It often happens that during a contact with a driver, a DMV employee may see or hearing something which indicates the driver may have issues with cognition.  In such a case, the employee will report their observations to a manager and an investigation will ensue.
• The Individual Driver:            Many times, the individual driver ends up being the source of information to the DMV.  This occurs commonly when a driver enters a DMV Field Office to renew their driver license and makes statements on applications that they have been diagnosed with a medical disorder.
• Social Media: We all live in a media driven world and the DMV is very much embedded in it.  It is not uncommon for DMV employees to see something unfavorable on Social Media and then begin an investigation.
• Anonymous Tipsters: The DMV will accept information regarding a potentially dangerous driver from any source, including those people who wish to remain anonymous.  It is common for Family, Friends or Caregivers to anonymously report a Dementia patient to the DMV in an effort to protect the public while keeping peace within the family.

 What should I do if I receive an Order of Suspension for Dementia?

It is estimated that as many as 500,000 Americans currently are diagnosed with Dementia and as our population ages, the numbers seem to be increasing exponentially.  The fact is, as human beings, we are frail creatures who are subject to any number of medical maladies, especially as we age.

Remember that a diagnosis with Dementia is not in itself a reason to stop driving.  One in three drivers with some form of Dementia are still able to drive– some for many, many years.

If you have received an Order of Suspension/Revocation from the California Department of Motor Vehicles (DMV) that was triggered because of an allegation of Dementia, the first thing to do is to take an honest assessment of your situation.  Speak honestly with your friends or family to analyze where you really stand from a position of cognition.  If you believe you are still stable enough to drive, contact the DMV Defense Experts at California Drivers Advocates.  We have been defending the rights of California Drivers for many years; including those who have been diagnosed with troubling medical disorders.   DMV defense is the only thing we do and we have represented hundreds of drivers who were on the verge of losing their driving privileges.

Yes, it’s true that a person diagnosed will eventually be forced to terminate driving, but that is true of all of us.  All of us will eventually get too old to drive.  Our goal at California Drivers Advocates is to help identify those people who truly do have Dementia.  We don’t want a person to lose their privilege to drive because of a simple misunderstanding or misconception.  If you do have Dementia, we work to keep drivers on the road enjoying their independence and freedom as long as it is reasonably possible. Call CDA today.  We care, and we have the training and knowledge to assist you.

Pick up the phone.  Professional and compassionate representation are just a phone call away.