Driving and dementia

Driving takes quick thinking, good judgment and fast reactions. Dementia slowly wears these skills down. Many people in the early stage can still drive safely for a while. But nearly everyone with dementia will need to stop at some point.^1,4

For many people, the car means freedom and pride. Giving it up can feel like a deep loss. This page helps families spot warning signs, get a fair driving test, understand the Virginia DMV medical review, and plan the talk with care.

Why dementia makes driving harder

Safe driving needs many brain skills at once. You must remember the route, read signs, judge speed and distance, and react fast when something changes. Dementia affects memory, attention, judgment and how the brain handles what the eyes see.^1,2

A key problem is that the person may not notice their own mistakes. This is often part of the illness, not stubbornness. Doctors call it anosognosia (when the brain cannot see its own changes). See when the person doesn't know they are ill.

Neurology experts found that when a person with dementia rates their own driving as "safe," it tells you very little.³ When a family caregiver rates the person's driving as unsafe or borderline, that is a more useful sign.³

Warning signs of unsafe driving

Watch closely, and if you can, ride along at different times of day. Signs to watch for include:^1,2

• Getting lost on roads they know well
• Forgetting where they were going in the middle of a trip
• Missing stop signs, red lights or other signs
• Driving much too fast or too slow
• Drifting out of the lane or hitting curbs
• Mistakes at intersections, or slow, poor choices in traffic
• Mixing up the gas and brake pedals
• Getting angry or confused behind the wheel
• New dents or scrapes on the car, near misses or crashes
• New tickets or warnings from police
• Simple errands that take much longer than they should
• Friends or neighbors saying they are worried

Keep a simple log. Write the date and what happened. Ask others who ride with the person to add notes too.⁵ This helps when you talk with the doctor, and it keeps the talk about facts, not feelings.

What the research says about risk

The American Academy of Neurology (AAN) wrote a guideline on driving and dementia in 2010. The AAN reaffirmed it in February 2025, so it is still in use.¹⁴ Here is what it found:^3,4

Source for the table: AAN guideline.³

In the studies the guideline reviewed, between about 4 in 10 (41%) and 3 in 4 (76%) people with dementia passed an on-road driving test.³ Many people with very mild or mild dementia can still drive safely for a time.⁴ No single test can predict who is safe.^3,4

The AAN advises doctors to check again about every 6 months for people who keep driving.³ For people with mild dementia (not just very mild), it says doctors should strongly consider advising them to stop.³

Getting a driving evaluation

A professional driving evaluation gives an outside, fair view. It can take the pressure off family members. It is best done early, while the person can still take part in planning.²

Who does it. A driver rehabilitation specialist. Many are occupational therapists (health workers who help people do daily tasks). Some hold the CDRS credential (Certified Driver Rehabilitation Specialist).^5,8

What it covers. In Virginia, the DMV says these evaluations look at thinking, judgment, reaction time and how the person judges space and distance.⁹ Ask the specialist what the visit includes and how long it takes.

How to find one. You can:

• Ask the doctor for a referral.
• Search the American Occupational Therapy Association's national list of driving specialists.^1,2
• Use Virginia's GrandDriver program. It lists driving testing centers around the state.¹¹

There is usually a fee.¹ Ask about cost and insurance before you book.

The specialist may say the person can keep driving for now, with limits such as daytime only or short, familiar trips. They may also say it is time to stop.^2,5 If driving continues, plan to check again.

The Virginia DMV medical review

Virginia's DMV has a team called Medical Review Services. It reviews drivers who may have a health problem that makes driving unsafe.⁸ Clinically trained nurses make the decisions, using rules written with a medical advisory board set up by the Governor.^8,13

Who can ask for a review

Anyone who has a safety concern can send a report. That includes family, doctors and police. Drivers can also report themselves.⁶

To report, write a letter or use the Medical Review Request (MED 3) form.^6,7 The form asks for the driver's name, birth date and address. It also asks what you saw and which tests you think are needed, such as a vision test or road test.⁷ You must sign it with your name.⁷

• Mail: Department of Motor Vehicles, Medical Review Services, P.O. Box 27412, Richmond, VA 23269-0001⁶
• Fax: 804-367-1604⁷
• Questions: Medical Review Services, 804-367-6203⁷

Phone numbers and forms can change. Check the DMV website before you send anything (as of October 2026).

Is my name kept private?

The driver can ask in writing why DMV is reviewing them. But Virginia law says DMV will not share the name of a relative or of the driver's own treating doctor, nurse practitioner or physician assistant who made a report.¹⁰ Reports from other people may be shared if the driver asks.⁶

What happens next

DMV sends the driver letters and forms. Often a doctor must fill out a medical report with the driver.¹³ Under Virginia law, DMV must give at least 15 days' written notice before it requires an exam.¹⁰

DMV policy for dementia. When DMV knows a driver has any type of dementia, or memory problems that may affect driving, its policy says the person must pass:⁹

1. The DMV knowledge test (the written test on rules of the road)
2. Then the DMV road skills test, with a medical report on file first

If the person fails the knowledge test three times, they need a driving evaluation with a driver rehabilitation specialist before one more try. DMV may also ask for a driving evaluation before any test. People who pass are checked again every 6 to 12 months.⁹

Possible results include:⁸

• No changes
• Driving with limits, such as no driving at night
• A knowledge test, road test or evaluation by a driver rehabilitation specialist
• Regular check-ins with the medical review team
• A short-term or longer suspension of the license

Refusing the exam, or not following limits DMV sets, can lead to losing the license.¹⁰ If you disagree with a decision, ask DMV about its appeals process.⁸

How to talk about stopping

This is one of the hardest talks a family can have. Plan for several talks, not just one.²

1. Start early. In the early stage, talk about how and when driving will end, before there is a crisis.² Some families write a simple driving agreement together. The Alzheimer's Association offers a sample.²
2. Choose the right messenger. Pick the person the driver trusts most. This might be a spouse, an adult child, a friend or the doctor.⁵
3. Gather facts. Use your log of what you saw. Talk about specific events, not general worries.⁵
4. Speak with kindness. Use "I" words, such as "I worry about you getting hurt." Avoid blame.⁵ Name the loss. It is OK to say, "I know this is hard."
5. Talk about what stays the same. Focus on how the person will still get to the places and people they love.^2,5
6. Bring in the doctor. Ask the doctor to advise stopping. A doctor's letter or a note that says "Do not drive" often carries more weight than family alone.^1,2
7. Talk first, then report. If you can, talk with the person before you contact the DMV.⁵
8. Review the plan. Look at the plan again at least twice a year.⁵

For more ideas on calm talks, see talking with someone who has dementia.

What if they refuse to stop?

• Stay calm, patient and firm. Repeat that you care about their safety and the safety of others.²
• Ask a respected relative, friend, faith leader or lawyer to back you up.²
• Ask the doctor to write a "Do not drive" order.¹
• Get a professional driving evaluation or ask for a DMV medical review.^1,6
• Do not blame yourself. The illness can make it hard for the person to see the danger.²

What if the person keeps driving anyway?

As a last resort, families sometimes hide the keys, disable the car, move it out of sight or sell it.^1,2 If you do this, always have safe rides ready at the same time.² Never leave the person stuck at home with no way to get around.

What about the doctor's role in Virginia?

Doctors can send a report to the DMV, and Virginia law keeps a treating doctor's name private from the driver.¹⁰ Ask the doctor what they plan to do, so the person is not caught by surprise.

Other ways to get around

Plan rides before the last day of driving. This keeps the person active and connected.^1,2

• Family, friends and neighbors. Make a weekly ride schedule. Faith groups and community groups may help too.¹
• Delivery. Have groceries, medicines or meals delivered to cut down on trips.²
• Taxis and ride services.² A family member can book the ride for the person and check that they arrived.
• Senior and paratransit rides. Many areas offer shared-ride vans for older adults and people with disabilities. Your local Area Agency on Aging can help you find free or low-cost options.^1,11
• Eldercare Locator: 800-677-1116. It connects you with local aging services, including transportation.¹
• Rides in Sight: 855-607-4337, for transportation information.¹
• Virginia: GrandDriver links to SeniorNavigator's transportation finder for Virginia.¹¹
• Adult day programs. Some offer rides to and from the center. See adult day care.

The Alzheimer's Association 24/7 Helpline at 800-272-3900 can also help you find local options.²

Caring for feelings after driving stops

Losing the car can bring sadness, anger or a sense of being cut off. Keep favorite routines going, such as church, coffee with friends or a weekly store trip. See loneliness in later life and apathy and depression in dementia.

Watch for signs of depression, such as losing interest in everything or talking about being a burden. Tell the doctor. If the person talks about wanting to die, call or text 988 right away, or call 911 if there is immediate danger. If there are guns in the home, see guns in the home.

Caregivers feel this loss too. You may feel guilt, even when you did the right thing. See caregiver stress and burnout.

When to get help

• Call 911 for a crash with injuries, or if a person with dementia drives away and cannot be found.
• Call the doctor soon if you see new driving mistakes, or if confusion gets worse quickly. A sudden change can have a treatable cause, such as an infection or a medicine side effect. See treatable conditions that look like dementia.
• Talk with the doctor about driving at every visit after a dementia diagnosis.⁴

For more on keeping a person with dementia safe, return to safety at home and outside. You can also read about early-stage dementia and making the home safer.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.