2010 BC Guide in Determining Fitness to Drive

Less commonly, dementias can result from: head injury and trauma brain tumours depression hydrocephalus (excessive accumulation of cerebrospinal fluid (CFS) in the brain) bacterial and viral infections toxic, endocrine, and metabolic causes, or anoxia.Some of these dementias may be reversible. Specific examples of reversible causes of dementiainclude: thyroid deficiency or excess vitamin B12 deficiency chronic alcoholism abnormal calcium levels dementia associated with celiac disease, and intracranial space-occupying lesions.Treatment for dementia has become available over the last decade with cognition enhancingdrugs such as donepezil (Aricept ), galantamine (Reminyl) and rivastigmine(Exelon). These drugs seem to improve symptoms of the disease in some stages of dementiabut their therapeutic effect is variable. It is generally considered not likely that treatment withmedication would improve cognition to a degree that would enable driving in those whosedriving skills had declined to an unsafe level or those who had previously failed a drivingassessment due to cognitive impairment.Mild cognitive impairmentMild cognitive impairment (MCI) is a term that usually refers to the transitional state betweenthe cognitive changes associated with normal aging and the fully developed clinical features ofdementia. The diagnostic criteria for MCI are evolving but in general it describes a cognitivedecline that presents no significant functional impairment.DeliriumDelirium is a condition characterized by a disturbance of consciousness and a change incognition that occurs over a relatively short period of time, usually hours to days. Commoncauses of delirium include: vascular disorders (e.g. stroke, myocardial infarct) infections (e.g. urinary tract, chest) drugs (e.g. analgesics, sedatives, alcohol, illicit drugs), and metabolic disorders (e.g. renal failure, hepatic failure, endocrine disorders).Although the symptoms of delirium may be similar to dementia, delirium is temporary andtherefore considered a transient impairment for licensing purposes.336