Parkinson’s
Disease &
Driving
Parkinson’s Disease and Driving
Driving is one of the most
important things that we do
on a daily basis. It is an essential
part of many of our activities of
daily living. It is how most of us
get to work, school and various
appointments; it’s how we travel
to and from household and
social activities. Driving gives
us independence and freedom.
Driving is a complex task that requires you to be aware at all times and be able to respond
quickly to the constantly changing circumstances. Anything that impacts or affects your
ability to drive should be taken into serious consideration. This includes Parkinson’s dis-
ease (PD), which has physical, mental and emotional symptoms.
Research shows that even healthy people outlive their ability to drive by several years and
most often this is due to changes in vision as we age. Most drivers however, do not plan
to retire from driving as they age. Many people realize when their driving skills are dimin-
ishing, often resulting in decreased confidence on the road. In some cases, the fear of
isolation or loss of independence overrides their judgment concerning their driving abil-
ities, resulting in denial of having any problems. This is especially true for those with Par-
kinson’s. People with Parkinson’s may be additionally fearful that the need to stop driving
indicates a progression in their disease.
If you have received a diagnosis of Parkinson’s disease, then you should be aware of how
the disease will affect your driving ability. This will help you to plan well in advance so you
can continue to do the things you used to do when you are no longer driving.
Parkinson’s disease (PD) is a very individualized disease. It differs from person to person.
Because driving is a complex activity that requires your full attention – physically, mental-
ly and emotionally – your ability to drive safely may be affected in different ways, and at
different stages of the disease. PD can affect your driving by affecting your mental clarity,
focus and ability to multitask. Slowness of movement may impact your reaction time.
Changes in your visual perception may impair your ability to judge distances between
other cars. Medication effectiveness, vehicle modifications and skills upgrading may only
delay the inevitable.
Driving Skills Assessment
At some point after being diagnosed with Parkinson’s, and before your symptoms be-
come too advanced, you should consider having your driving skills properly assessed. For
a person with Parkinson’s (PWP) this assessment is two-fold: assessing their general driv-
ing skills relating to natural aging and assessing those affected by the PD symptoms. You
may want to ask someone you trust to take a drive with you and help you evaluate your
driving using the following checklist:
Driving Skills Yes No
Remembers to buckle seat belt.
Checks and adjusts mirrors as needed.
Transitions from one pedal to the other with ease.
Comes to a stop at the appropriate time and distance.
Remembers to use appropriate signals when
changing lanes or turning.
Checks ‘blind spots’ by turning neck and upper body
with relative ease.
Remains within the lane without straying.
Drives at the appropriate speed with consistency.
Adjusts their speed to traffic and road conditions.
Obeys traffic rules, stops and signals.
Yields the right of way as appropriate.
Aware of other cars, bikes, riders, pedestrians on the road.
Reacts in a timely manner to changing driving situations.
Knows where they are at all times, especially on familiar routes.
Plans ahead for exits and turns.
Puts the vehicle into park upon parking.
Red Flags
Oftentimes, those with conditions that affect their driving are aware of several ‘red flags’
that indicate their driving skills are declining and safety may be an issue. Those with
Parkinson’s may wish to realistically assess if any of the following applies to them:
Red Flag Questions Yes No
Have you had any ‘close calls’ or ‘near misses’?
Have you had any at-fault motor vehicle accidents
or ‘fender benders’?
Have you been the recipient of honks or unpleasant
comments from other drivers?
Have family or friends refused to ride in the car
when you are driving?
Are you no longer allowed to drive your grand-children around?
Have family or friends told you they are concerned
about your driving?
Have you failed to park your car after numerous
attempts to do so?
Have you received any tickets for any traffic violations?
Has your car insurance premium been raised
due to traffic violations or at-fault accidents?
Have you been driving and somehow gotten lost
in areas familiar to you?
Have you had trouble reading street signs or seeing
traffic signals in time to respond?
Have you experienced problems following or
remembering directions?
Have you experienced issues responding to changing
driving situations?
Have you had moments of confusion, especially on familiar routes?
Have you had problems planning your exits and turns?
Have you forgotten to put the car into park upon parking?
Improving Your Driving Skills
Everyone can benefit from improving their driving skills, particularly those with
Parkinson’s. Consider the following:
• Ask your doctor if your medications can affect your driving skills and
be honest in reporting sleepiness or dizziness
• Be aware of your energy levels throughout the day and avoid driving
during “off” periods
• Practice good sleep hygiene techniques as much as possible to help with
fatigue and only drive when well rested
• Avoid driving when medications are not working optimally
• Stay fit and physically active to maintain the range of motion and reaction time
needed for driving and help with your energy level
• Work on stretching your neck and torso to maintain the flexibility needed to look
over your shoulder while driving
• Maintain good posture to provide support and visual access while driving
• Eliminate distractions while driving:
• Listening to the radio
• Talking with a passenger
• Avoid cell phone usage - even hands-free. Having a long
conversation on a speaker phone can cause you to get distracted.
• Eating or drinking
• Avoid driving after dark (our vision changes as we age)
• Avoid driving in bad weather
• Choose familiar, comfortable routes at non-peak
hours whenever possible
• Consider using a GPS system in your car
• Share driving responsibilities whenever possible
• Drive a little slower – but remain in the safe range
• Stick to short-distance trips whenever possible
Talking to the Driver with
Parkinson’s Disease
Talking to any person about their driving can be challenging. If you have noticed a decline
in the driving skills of someone you know with PD, you may want to do the following:
1
Ride along as a passenger with the PWP to see first-hand how they are behind the
wheel. Assess their driving skills using the checklist in this booklet. If you have any
concerns, do not bring them up while they are driving!
2
Address the behaviours, not the person with Parkinson’s, when you share your concerns
with them. Avoid the blame and shame game. Consider the following examples:
Say Do Not Say
“ You seemed to be a little confused at
that intersection and I felt nervous as you
didn’t appear to know how to get out of
the situation.”
“ You got totally confused at
that intersection. You didn’t
have a clue what to do and
you scared me!”
“ This afternoon, you were only doing 30km
an hour when we were out and the speed
limit along most of the route was 50km.
Did you notice the cars lined up behind us?
Is that common for you?”
“ You were driving so slowly this
afternoon that half the traffic on
the road was piled up behind us
– didn’t you see that?”
3
Prepare for some defensiveness and emotions. Driving is an important part of
independence and self-worth. Rec
ognize and acknowledge the PWP’s past good
driving record, if appropriate. Focus the discussion on the present.
4
Discuss their emotions and express empathy. Acknowledge and validate that
giving
up driving is a loss that requires a difficult period of transition.
5
Together
, agree on a plan of action and time-frame. Self-imposed limitations
may be the immediate option.
6
If you meet with adamant resistance, talk about the risks. Discuss the risks and
dangers to the PWP and others if they continue driving unsafely. Talk to the
health care team for support.
Here are the research findings
1
identifying persons with
Parkinson’s (PWPs) as being
less safe than non-Parkinson’s
drivers. Some of the problems
identified include:
• Longer reaction times
• Problems shifting feet
between pedals
• Difficulties with
lane changing
• Checking ‘blind spots’ due to
neck and upper body stiffness
• Reduced steering accuracy
• Responding to light changes
due to vision impairments
• Difficulties parking
and/or reversing
• Inability to break suddenly
due to muscle cramping or
leg edema from medications
• Reduced memory capabilities
• Slower judgement and
decision-making
• Confusion due to early dementia
• Excessive daytime sleepiness
due to disease or medications
1 Foley DJ, Heimovitz HK, Guralnik JM, Brock DB. Driving life expectancy of
persons aged 70 years and older in the United States. Am J. Public Health
2002;92(8):1284-9.
Transportation Options
Develop a list and plan for other forms of
transportation. Further, develop a transition
plan
to a non-driving lifestyle. Here are some tips:
• Explore public transportation
• Cost benefits - can be less expensive than maintaining a car
(care, insurance, parking, etc.)
• Transportation for persons with disabilities and seniors - there may
be existing parallel transportation systems, with door to door service
• Investigate volunteer driver services offered by some agencies
• Look into the costs of rideshare programs - e.g. Uber, Lyft™
• Approach a retired neighbor or friend for a lift
Legislation
Parkinson’s Disease is a progressive disease displaying both motor and non-motor
symptoms, and the medications used to treat those symptoms have numerous side-effects.
The Canadian Council of Motor Transport Administrators (CCMTA), in their Determining
Driver Fitness in Canada (2015) publication, state that there is “a small but consistent
body of research indicating that functional deficits associated with Parkinson’s disease
or its treatment may impair driving performance.” They go on to say that a “further
consideration for driving is the fluctuation in the effects of the medication” resulting
in ON and OFF-periods.
Also, according to the CCMTA, a driver’s reassessment will be required if “the driver has
a medical condition that is progressive”, and a driver reassessment is required - at a
minimum - every 5 years if the condition is progressive. However, a reassessment interval
can be set at one year if “a driver’s cognitive function is impaired and the level of
cognitive impairment is likely to increase over time”.
The Canadian Medical Association’s Driver’s Guide – 9
th
edition (2017) states the following:
“ During the early stages, Parkinson’s disease affects only fine coordination and
therefore should not affect fitness to drive. With progression, impairment of
the speed of gross movements and of reaction time may begin to make driving
unsafe. The situation can be worsened by any associated cognitive impairment,
side effects of medications (ex. somnolence, involuntary movements, hallucina-
tions) and an increasingly unpredictable response to medication leading to
“wearing off” and other motor function fluctuations”. They continue in saying,
“The main concern is a delay in reaction time in response to complex traffic
situations, which increases the risk of collision. Periodic assessment of cognitive
processing speed will help in determining changes in reaction time.” For this
reason, cognitive testing may be performed regularly by your health care team,
followed by an on-road driving test, as deemed necessary.
Remember, your health care provider is responsible for identifying and assessing drivers
who may be unfit to drive. In some provinces, physicians are legally bound to report
certain medical conditions that may affect driving. For more information, contact your
provincial ministry of transportation or transportation and driving authority.
It is important to remember that driving is not a right, but a privilege that carries certain
risks. Giving up your driver’s license can be an emotionally charged and upsetting process.
It may mark the end of a stage in your life as a driver and a loss of independence. It also
means that many of the activities that you once participated in, or managed on your own,
will have to be changed, or performed by someone else. Your family and your health care
team will help support you through this challenging process to ensure your safety and
the safety of others.
For more information on provincial
legislation, contact your provincial
Ministry of Transportation.
ALBERTA
1-780-427-8230
310-0000 (Toll Free
within Province)
Main Floor
Twin Atria Building Alberta
Transportation
4999 – 98th Avenue
Edmonton, AB T6B 2X3
BRITISH COLUMBIA
1-800-663-7867
1-250-387-6121 (Victoria)
1-640-660-2421 (Vancouver)
P.O. Box 9055,
Prov. Stn. Govt.
Victoria, BC V8W 9E2
MANITOBA
1-204-945-8912
200 - 301 Weston Street
Winnipeg, MB R3E 3H4
ONTARIO
1-800-268-4686
1-416-327-9200 (Toronto)
77 Wellesley Street West
Ferguson Block, 3rd Floor
Toronto, ON M7A 1Z8
NEW BRUNSWICK
1-506-453-3939
King’s Place
P.O. Box 6000
Fredericton, NB E3B 5H1
NEWFOUNDLAND
1-709-729-4834
100 Prince Phillip Drive
P.O. Box 8700
St. John’s, NL
A1B 4J6
NORTHWEST
TERRITORY
1-867-767-9087
New Government Building
5015 – 49th Street, 1st Floor
Yellowknife, NT X1A 2L9
NOVA SCOTIA
1-800-670-4357
1-902-424-5200
Public Enquires
Nova Scotia
P.O. Box 2734
Halifax, NS B3J 3K5
NUNAVUT
1-867-975-7840
Gov. of Nunavut
Motor Vehicles Division
1104C Inuksugait Plaza
P.O. Box 1000, Stn. 1575
Iqaluit, NU X0A 0H0
PRINCE EDWARD
ISLAND
1-800-236-5196
(General Inquiries)
1-902-368-5271
(Driver’s License)
P.O. Box 2000
Charlottetown, PE C1A 7N8
QUÉBEC
1-800-361-7620
1-418-643-7620 (Québec)
1-514-873-7620 (Montréal)
Case postale 19600
Succursale Terminus
333, boulevard Jean-Lesage
Québec, PQ G1K 8J6
SASKATCHEWAN
1-844-855-2744
SGI
2260 - 11th Avenue
Regina, SK S4P 0J9
YUKON
1-800-661-0408
(Toll Free in Territory)
1-867-667-5315
motor.vehicles@gov.yk.ca
4211 Yonge St, Suite 316, Toronto ON M2P 2A9
|
1.800.565.3000
Parkinson.ca
|
Parkinsonclinicalguidelines.ca
This resource was created by Parkinson Canada with input and review from:
Beth Robertson, BSc. Biol., BSc. OT, McGill University
Montreal Neurological Hospital
Movement Disorders Clinic
Member of the Parkinson Canada Medical Advisory Committee
Chair of the MUHC Multidisciplinary Council for the Maintenance and Promotion of Education
Anne-Louise Lafontaine MD, MSc, FRCPC
Chief, Dept. of Neurology, MUHC
Director, McGill Movement Disorder Clinic
Associate Professor and Associate-Chair, Neurology
Dept. of Neurology and Neurosurgery
Lucie Lachance, B.Sc (N), M.Sc
Clinical Nurse Specialist
Movement Disorders Program
McGill University Health Centre
Parkinson’s Foundation Center of Excellence
McGill University
