Cognitive Impairment and Dangerous Driving: A Decision Making Model for the Psychologist to Balance Confidentiality with Safety


The Transitional Opportunity Partnership (TOP) is a framework for psychological care of cognitively impaired individuals. In this paper we address the issues associated with cognitively impaired drivers and how the TOP model can assist psychologists in managing the ethical, legal, and moral dilemmas that often occur with this challenging population. This paper offers suggestions for how to therapeutically manage the privilege of driving with cognitively impaired individuals, through client education, increasing awareness of client resistance or in-capacity to recognize impairment, and proactive intervention.

Share and Cite:

Love, C. , Costillo, J. , Welsh, R. , Scott, S. & Brokaw, D. (2011). Cognitive Impairment and Dangerous Driving: A Decision Making Model for the Psychologist to Balance Confidentiality with Safety. Psychology, 2, 254-260. doi: 10.4236/psych.2011.23040.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] American Bar Association. (2005). Assessment of older adults with diminished capacity. Washington, D.C.: Author.
[2] American Medical Association. (2002). E-2.24 Impaired Drivers and Their Physicians. Chicago: Author.
[3] American Psychological Association. (2002). Ethical principles and code of conduct. American Psychologist, 57(12), 1060-1073.
[4] APA Presidential Task Force on the Assessment of Age-Consistent Memory Decline and Dementia (1998). Guidelines for the evaluation of dementia and age-related cognitive decline. Washington, D.C.: American Psychological Association.
[5] Berger, J. T., Rosner, F., Kark, P., & Bennett, A. J. (2000). Reporting by physicians of impaired drivers and potentially impaired drivers. Journal of General Internal Medicine, 15, 667-672.
[6] California Business and Professional Code, § 2960, (2004).
[7] California Civil Code, § 1708, (2004).
[8] California Evidence Code, § 1024, (2005).
[9] California Vehicle Code, § 12806, (2004).
[10] Carr, D. B., Duchek, J., & Morris, J. C. (2000). Characteristics of motor vehicle crashes of drivers with dementia of the Alzheimer type. Journal of the American Geriatrics Society, 48(1), 18-22.
[11] Currie v. United States, 644 F. Supp. 1074; 1986 U.S. Dist. LEXIS 19491.
[12] Dubinsky, R. M., Stein, A. C., & Lyons, K. (2000). Practice parameter: Risk of driving and Alzheimer’s disease (an evidence-based review) - Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 54, 2205-2211.
[13] Ewing v. Goldstein, 120 Cal. App. 4th 807; 15 Cal. Rptr. 3d 864; 2004 Cal. App. LEXIS 1131; 2004 Cal. Daily Op. Service 6427; 2004 Daily Journal DAR 8707.
[14] Faulkner, A., Maguire, P., & Regnard, C. (1994). Breaking bad news - a flow diagram. Palliative Medicine, 8(2), 145-151.
[15] Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
[16] Gammon, T. E. & Hulston, J. K. (1995). The duty of mental health providers to restrain their patients or warn third parties. Missouri Law Review, 60, 749-797.
[17] Gerber, T., Henry, M. E., Bunn, G., Baumel, E., & Stacy, A. (1989). A state population-based statutory reporting of dementias. Journal American Medical Record Association, 60(1), 24-32.
[18] Hinton, W. L., & Levkoff, S. (1999). Constructing Alzheimer’s: Narratives of lost identities, confusion and loneliness in old age. Culture, Medicine & Psychiatry, Special Issue: Aging, ethnicity, and dementia: Family caregiving, 23(4), 453-475.
[19] Holmén, K., Ericsson, K., & Winblad, B. (2000). Social and emotional loneliness among non-demented and demented elderly people. Archives of Gerontology and Geriatrics, 31(3), pp. 177-192.
[20] Hunt, L. A. (2003). Driving and dementia. Generations, 27(2), 34-38.
[21] Jennings, B. (2001) Freedom fading: On dementia, best interests, and public safety. Georgia Law Review Association, 35, 593-619.
[22] Johnson, T. F. (1999). Ethical issues in decision making: A balanced interest perspective. In T. F. Johnson (Ed.), Handbook on ethical issues in aging (pp. 326-339). Westport, CT: Greenwood Press.
[23] Knopman, D. S., Boeve, B. F., & Petersen, R. C. (2003). Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clinic Proceedings, 78, 1290-1308.
[24] Lipski, P. S. (1997). Driving and dementia: A cause for concern. The Medical Journal of Australia, 167, 453-454.
[25] Menne, H. L., Kinney, J. M., & Morhardt, D. J. (2002). ‘Trying to continue to do as much as they can do’: Theoretical insights regarding continuity and meaning making in the face of dementia. The International Journal of Social Research & Practice, 1(3), 367-382.
[26] Messinger-Rapport, B., & Rader, E. (2000). High risk on the highway: How to identify and treat the impaired older driver. Geriatrics, 55(10), 32-45.
[27] Morris, J. C. (1993). The clinical dementia rating (CDR): Current version and scoring rules. Neurology, 43, 2412-2414.
[28] Niveau, G., & Kelley-Puskas, M. (2001). Psychiatric disorders and fitness to drive. Journal of Medical Ethics, 27(1), 36-39.
[29] Rowland v. Christian, 69 Cal. 2d 108; 443 P.2d 561; 70 Cal. Rptr. 97; 1968 Cal. LEXIS 231; 32 A.L.R.3d 496.
[30] Reger, M. A., Welsh, R. K., Watson, G. S., Cholerton, B., Baker, L. D., & Craft, S. (2004). The relationship between neuropsychological functioning and driving ability in dementia: A meta-analysis. Neuropsychology, 18(1), 85-93.
[31] Small, G. W., Rabins, P. V., Barry, P. P., Buckholtz, N. S., DeKosky, S. T., et al. (1997). Diagnosis and treatment of Alzheimer disease and related disorders: Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. Journal of the American Medical Association, 278(16), 1363-1371.
[32] Smith-Bell, M., & Winslade, W. J. (1994). Privacy, confidentiality, and privilege in psychotherapeutic relationships. American Journal of Orthopsychiatry, 64, 180-193.
[33] Spano, J., & Groves, M. (2006, October 21). Driver guilty of felony in market crash. The Los Angeles Times, Main News; Metro Desk; Part A; Pg. 1.
[34] Stenger, C. E. (1996). Taking Tarasoff where no one has gone before: Looking at “duty to warn” under the AIDS crisis. St. Louis University Public Law Review, 15, 471-504.
[35] Tarasoff v. Regents of University of California, 13 Cal. 3d 177; 529 P.2d 553; 118 Cal. Rptr. 129; 1974 Cal. LEXIS 376.
[36] Tarasoff v. Regents of University of California, 17 Cal. 3d 425; 551 P.2d 334; 131 Cal. Rptr. 14; 1976 Cal. LEXIS 297; 83 A.L.R.3d 1166.
[37] Valcour, V. G., Masaki, K. H., & Blanchette, P. L. (2002). Self-reported driving, cognitive Status, and physician awareness of cognitive impairment. Journal of the American Geriatric Society, 50, 1265-1267.
[38] Woods, R. T. (1996). Psychological “therapies” in dementia. In Woods, Robert T. (Ed.), Handbook of the clinical psychology of ageing (pp. 575-600). Oxford, England: John Wiley & Sons.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.