WEBVTT

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I\'m on schedule to get my license back now and
I feel very confident and I am feeling better.

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For once, we get in the car; I
mean it\'s always the same issues.

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I mean explaining to him why he
not allowed to drive is just –

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it\'s daily, we explain it daily. And
sometimes we get a little frustrated.

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Even though he has a lot of memory
loss, the one thing he doesn\'t forget

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is that he can\'t drive. I mean
it\'s such an emotional attachment,

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him and driving, I mean that\'s his independence
that is just – he has never let go of that.

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I\'ve been driving all my life

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and I still feel that I can drive, Although
the doctors have restricted me from driving.

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Well dad, you don\'t have a license and
till you produce, the club stays on.

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It\'s a very objective – you know, really
objective not being able to drive.

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And uh… I feel that I see
some people out there

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driving that are not as good drivers as
I am and they still have their license.

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So, I – I complain about
it just about daily

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and just about hourly. But uh… at any rate,

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I am going through a

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certain amount of hoops and
doctors\' instructions and that –

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I\'ve been told that I\'ll get my license
back. So, I\'m counting big on that.

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Even the year before he actually started to
really decline, like before we even found

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he was going mini strokes, I mean we wouldn\'t get in a vehicle with him
and we didn\'t want my mother getting into a vehicle with him either

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because he was just so preoccupied

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and – I mean dangerous. I mean
I would go pick up my mom.

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If we were going somewhere to a family dinner or something,
I go pick up my mother and my dad would drive his truck

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because we didn\'t want her getting in with
him. But of course, we didn\'t realize also,

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like he was having numerous mini strokes
throughout the last two or three years, you know.

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At that point, did you address the
driving issue with him at all or not?

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Uh… no. I mean there\'s just no way you
could – driving has been his life.

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I mean that\'s – everything connected to him is driving.
Every job he\'s ever had required a lot of driving.

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I mean there was no way we
would ever think to take –

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you know, discuss him not driving. As
a matter of fact, he always tells us

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how he is very upset with us because
even if it means he\'s breaking the law,

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like he would never tell his
parents, they couldn\'t do something.

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And he doesn\'t know where we get off, you know, trying to
control him of tell him that he\'s not allowed to drive.

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It is – it\'s definitely frustrating
to not have a driver\'s license

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and not be legal to drive.

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But I am following all the doctor\'s orders

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and suggestions and he tells me that –

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that I will be getting my driver\'s license
back. So, that\'s – that\'s encouraging.

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What if you don\'t, dad? What
if you don\'t get it back?

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I – I believe the doctor.

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He said that –

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I think the only other things that we can talk about is how you
kind of think that me and Mark and Carla stole your truck from you.

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Well, that was a little bit aggravating.

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But I suppose –

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I suppose I\'ve been
aggravating sometimes too.

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So, your kids sometimes get even with you.
Do you think that\'s what we did? Yes.

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Do you think we took your truck
from you to get even with you?

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Well, it\'s … Dad? Well, it
wouldn\'t be surprising.

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What are we going to get even with you for?
Dad, that\'s ridiculous. That is ridiculous.

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I mean it\'s one thing to think
that we stole you truck

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because you were incapacitated. But to
get even is – that\'s a little annoying.

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Well, it\'s a little annoying
with you come and request my –

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that you need my truck and I agreed to let
you use my truck. And then I find out

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that you\'ve just absconded with it.

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Absconded. Well, first of all the doctor was the
one who advised us to get all your paperwork

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in order before your triple bypass and was the one
that suggested that we have the truck signed over

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to a family member. And you know,

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thankfully so because – I mean if you were in that
truck right now dad, you\'d be breaking the law.

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So, I mean we didn\'t – we didn\'t
– we\'re doing you a favor.

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Well – I mean your truck would be
impounded right now with you in it.

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Oh yes, okay. And we\'d all be held accountable
for you driving it. Yeah, I\'m not mad about it.

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I know that you kids have always treated me very,
very well. Yeah. So, I have no complaints.

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Well, your trucks are in front of the house
where you can see it. When Mark had it,

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I kind of understand you wondering where it\'s at
and stuff. We put it back where you can see it.

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I mean every day – I\'ll get
sometimes four or five phone calls

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from my dad wondering when he can take his
drive able test which he can\'t at any moment.

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Like I said, I\'ll book it any time you want. But in between
that, like when I offered to make the appointment,

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he wants to wait a few days.
But, I mean it\'s daily,

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he wants to go talk to the police. He\'s daily
at registries. He walks over to registries

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to find out the status of his license.
Can I have your ID please? Yes.

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What status are – are you standard or …?
Well, I think perhaps (inaudible).

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But I\'m just wondering – For what were
you (inaudible)? For health reasons.

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Health reasons? All right.

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Yes you are. We can\'t do anything for you.
You do have to contact license enforcement.

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I\'ll give you their phone number and you contact them
and they\'ll tell you exactly what has to be done.

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Okay, thanks. What does it
say on my license right now?

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Right now, you\'re not supposed to be driving at all.
It says you are suspended for medical conditions.

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I try and make myself available so
that he doesn\'t feel trapped at home.

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But when once we get in the car, I mean, it\'s always the
same issues. He wants his – he does have his license.

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Actually, he won\'t hand it in. Like, he won\'t give it
up. He said he\'ll jump over a counter if somebody tries

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to take it from him. We don\'t know what to do with
him. We just tell him you\'ll never drive again

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or try and encourage him that once he gets healthier,
you know, maybe he can have his license back.

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I mean, we don\'t know what to do, you know.

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Like I said, I brought him into the police station
three, four different times. The cops have talked to him

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for up to now an hour and half explaining
to him. And with his vascular dementia,

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he just … we leave, we get in the car and he says
he wants his license back, why can\'t I drive.

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I\'ve been told that I have
some mental problems.

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But I\'m really not willing
to accept that as a fact.

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I … I really believe I\'m
still in pretty good shape.

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It\'s hard for … like my mom because she …

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when we … my sister and I leave, like we\'re the
caregivers too, but she actually lives with him.

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I mean he rants and raves like
he\'ll really get on her case.

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There\'s something about – about not
giving around and being active.

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It implies that a person
is a less than a man.

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Something we would often talk about is like what\'s going to
happen if he doesn\'t pass. And I\'m not saying you won\'t.

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But, it is a concern for all of us.
You know,

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we don\'t know how he\'ll deal with it. I think he
will be – it\'s such an emotional issue for my dad

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to have his license, it\'s like I said, the key to
really, like well now he said it, being a man.

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I don\'t know what … I
think he\'ll be depressed

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and I think … I don\'t know. I don\'t know how he\'ll
react if you didn\'t get your license, I don\'t …

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I\'m not sure – not that my – in
my present health and condition.

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You\'re already getting a little crabby.

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I have never been crabby.

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Yes, you are. I mean I just
get stroke – another stroke.

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Because you get little strokes every other
time and I hope that doesn\'t happen,

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but if you can – if you don\'t – you
know – you might get another one.

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Well, we hope he doesn\'t. But she does …
she says I think you\'ll have a big stroke

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if he doesn\'t get his license. It\'s just the
way I see him is just you know, that he –

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right now I did little things bother
him and I think it\'s going to be –

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get – his anger is going to get
strong and his frustration

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is all about just not being able to drive …
drive and it\'s going to really get to him.

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And I don\'t know if you can be
– if he\'ll be able to take it.

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With all the doctors that my father has right now, I mean I
guess they\'ve all just kind of decided to pull his license.

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So, his family doctor is actually like

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the head guy that gets all the information.
So, my dad wants to go see Dr. Adams,

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that\'s his doctor, everyday to find out if he
can … you know, why he took his licenses away.

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And one of the things that I very much
want back is my driver\'s license.

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But I do believe I have to have your
recommendation and your thoughts on

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my ability to drive before
I would get it back.

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That\'s correct. He\'s\' been doing this
for the last, probably 10 months.

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He comes in about once in a month and so now
he\'s starting to get that urge again to …

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I\'m feeling better, I can do better. But when
I talk to his family, he\'s not doing better.

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When I talk to his other doctors that he takes care of
him, no, he\'s not doing that. But if I take away his hope,

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then I\'ve just taken away his life. I
know I\'m improving each day and I feel …

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And that\'s why we – that\'s why we have gone
farther now in making sure that like …

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because you continue to improve, that\'s why we\'ve
said, you know, if you\'re still improving,

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the better way to do it is to make sure that you get to
that plateau that you\'re … hey, I feel confident now.

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I feel like I can do something and
then try it. Yes. I agree with that.

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And uh… I\'m – I\'m not going to go for the test even
today because I don\'t have any pressing reason

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not to do it for a week or two. And uh… I
feel that I\'m still improving each day.

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That … That\'s good. He\'s been
given a diagnosis of a dementia.

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He\'s been told there\'s lot of things that are
going to happen; some of them he remembers,

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some of them he doesn\'t. But he still has that … like
the last hope of I want to have my freedom back.

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And right now, he\'s accepting that he can\'t
do that. And with that hope that he can.

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And so, yes, we\'ll have to face that at some time.
But right now we\'ve had it almost nine months

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where we can allow him to
still be happy with life.

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And I was within two blocks, I can
see the street as I could take.

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But somehow I was disoriented
and I bypassed that street.

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And I went around and around into finally

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I succumbed to umm… fatigue.

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I had fallen asleep at wheel.
I hit a tree …

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like imagine a tree is straight up and down
like that and a car trying to get to the top.

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I woke up. I thought I was dreaming.

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He was gone six hours and this is for
midnight till six in the morning.

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And I was very concerned. I had called the police
by this time because I didn\'t know where he was.

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And when he finally did call,

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the police came, but he
called just as they arrived

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and he really didn\'t even
know where he was then.

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What really got me as one time
we went to the supermarket,

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Jewel near here and there was
in my mind, I saw a line,

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this yellow line, you know, over here.
So, I moved in the other direction,

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but it wasn\'t. It was an
illusion, like – I can\'t –

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I don\'t know if it really was an illusion, but it
was not a true line. He went into the other lane

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and I … I screamed. I thought
my wife was (inaudible),

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you know, when she – this close – miss,
you know, oh, you hit that truck,

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oh, you almost knocked that lady. Now you
just imagine – you\'re imagining things.

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You\'re just over run, you didn\'t have enough sleep.
Yeah. He just tells me that I had the heebie-jeebies

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and I was terrified. Oh!

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The other thing is when I went to the
hospital to visit, I parked the car.

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And I uh…

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came – was coming home and
I was driving too fast.

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I didn\'t know that. I was driving
and I – came up to the ramp

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to cross the bridge to come on
this side and I hit the car …

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a truck, a small truck

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with a low metal knob on
the top and hit the car.

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And I told my wife a lie – see
someone in the garage must have –

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not me, someone must have hit it. I
never heard this. Yeah. Well, good.

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Now, I come clean. But I
said something is wrong.

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There\'s no reason for me … I don\'t
exceed the speed. I\'m a good driver

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when I\'m right. This was broad daylight.
It was no reason at all

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for me to go at fast that I
couldn\'t control the car

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to stop in time. So, I just assumed this
was wrong. Another time he looked –

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he was moving the car as
though he was going to go off

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the express way for no reason,

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you know, like – it really wasn\'t a ramp there.
And he had a lot of trouble staying in the lines.

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I would convince myself that

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I have to be more careful.
That\'s how I smooth it out.

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Yeah, I would think so as well and I think that was the
reason for the other accident because he – he started getting

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quite careful on the express
ways and driving slowly,

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you know, to the point … Too slowly. Yeah, to the
point where I didn\'t think that was very good either.

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But I made so many mistakes

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that I had to come to realization, I don\'t
have it anymore. Something is wrong.

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We were just lucky because he had the accident. I did
call and I left a very detailed message with the doctor.

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Voyer doesn\'t know that I did that.
I hate you.

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No, you don\'t. You\'re crazy about me.
You deceived me.

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No. Anyway – so, the
doctor then did, you know,

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exceed to me concerns and really
talked to him for a very long time

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and he began to realize after he
was – see, Voyer is very verbal.

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And unless you have an opportunity to
listen to him for a very long time,

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you don\'t realize that there\'s something
wrong. Doesn\'t repeat himself right away.

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So, that\'s when I took the initiative,
my wife and I went to the doctor

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and they did the examination and little
simple tests like connecting a line –

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connecting … reconnecting a separate line
and then I couldn\'t do it or properly.

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Something is wrong, you know.
So, I had to face reality.

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You have a choice. You can
ignore the advice of the doctor

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and continue to drive, continue to
have near miss until you get that one.

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I\'m really glad that he doesn\'t
drive for everyone\'s sake.

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I reconcile myself to the fact that

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it\'s not safe for me to drive and I follow the
doctors, it will be criminal for me to drive now.

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Were you guys in that position
where you were saying,

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you know, I don\'t think you should drive anymore and
you were kind of resenting that she was saying that?

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Yeah, we did to have those discussions
or those arguments because

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that\'s what really they would turn out to be.
Oh, fights. You know, just you know, opinion –

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I say I don\'t agree with you. You\'re over run – you know,
that time – that – as far as that. But I\'m not I hate you,

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nothing like that. But I
felt that she takes a

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small thing and escalates it to a larger –

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that\'s my feelings, you know. But
she was looking out for me, really.

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Yeah. We did have some words. But
obviously they didn\'t tear us apart

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because we\'re still here. It
wasn\'t hard – I wouldn\'t call –

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Now once … a couple of times he said,
well, do you want to do the driving

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and I was really wanting to say to yes.
But I don\'t think that

00:17:45.000 --> 00:17:49.999
he would have taken that as a real yes.

00:17:50.000 --> 00:17:54.999
Well, that wasn\'t anything high key;
it was just a feel of your opinion

00:17:55.000 --> 00:17:59.999
and my opinion where I felt I had
the ability because of my years

00:18:00.000 --> 00:18:04.999
in various vehicles that I
could match the driving.

00:18:05.000 --> 00:18:09.999
If it had not been for the
intervention of the doctor,

00:18:10.000 --> 00:18:14.999
do you think that this would have gone on longer
between the two of you, this kind of disagreement?

00:18:15.000 --> 00:18:19.999
Yes, absolutely. I believe so, yes.
I have to admit that.

00:18:20.000 --> 00:18:24.999
I mean I really do think
in a married couple,

00:18:25.000 --> 00:18:29.999
there are so many issues so
often and they\'re not willing

00:18:30.000 --> 00:18:34.999
to accept their spouses\' determination
of something like that.

00:18:35.000 --> 00:18:39.999
You really need an outside
person who has no … Interest.

00:18:40.000 --> 00:18:44.999
No interest in either of the other.

00:18:45.000 --> 00:18:49.999
So, I don\'t want to tell him that he can\'t drive
and that I think there\'s something wrong with him

00:18:50.000 --> 00:18:54.999
because he\'ll get angry and that of
courses is the crux of the matter.

00:18:55.000 --> 00:18:59.999
I wanted someone else to make that
decision he wouldn\'t then, not blame me,

00:19:00.000 --> 00:19:04.999
but think of me as being the bad guy.
Someone else has to be the bad guy.

00:19:05.000 --> 00:19:09.999
We get to where we want to go.
She does the driving.

00:19:10.000 --> 00:19:14.999
I can nag her for a change and
say, oh, watch out for that girl,

00:19:15.000 --> 00:19:19.999
watch out for that truck.
You\'re too close. Damn it.

00:19:20.000 --> 00:19:24.999
We take public transportation
wherever we needed

00:19:25.000 --> 00:19:29.999
and I have my proud pass, you know, I show
it off, you know, and thank the driver

00:19:30.000 --> 00:19:34.999
and go on and we get where want to go.
Another thing is I\'m retired now.

00:19:35.000 --> 00:19:39.999
And he was pretty much retired
when all of this was happening.

00:19:40.000 --> 00:19:44.999
So, you know, we are able to go places.
You know, I\'m able to drive.

00:19:45.000 --> 00:19:49.999
Sometimes it\'s a little frustrating for
him because he wanted to do something …

00:19:50.000 --> 00:19:54.999
go somewhere immediately and I
don\'t see any reason to do that.

00:19:55.000 --> 00:19:59.999
And then he\'ll say, oh, if I were driving
then I would be able to do that.

00:20:00.000 --> 00:20:04.999
And I\'d say well, we\'ll go tomorrow.

00:20:05.000 --> 00:20:09.999
But we\'re going to survive that one. Yeah. I
appreciate her. She helped me a lot, you know.

00:20:10.000 --> 00:20:15.000
And thank goodness I had some sense.

00:20:25.000 --> 00:20:29.999
I\'ve known there was something wrong with my memory
for awhile and they were tracking me at North Western

00:20:30.000 --> 00:20:34.999
for a long time. And at one time …

00:20:35.000 --> 00:20:39.999
one thing that sticks out of my head was

00:20:40.000 --> 00:20:44.999
uh… they had done a neural psych
evaluation and my recall had …

00:20:45.000 --> 00:20:49.999
my short term recall had
gone from 80% to 20%.

00:20:50.000 --> 00:20:54.999
And that really … it was
wake up call to me.

00:20:55.000 --> 00:20:59.999
The rehab institute has recommended

00:21:00.000 --> 00:21:04.999
that I don\'t travel from here
to Saint Louis by myself.

00:21:05.000 --> 00:21:09.999
[sil.]

00:21:10.000 --> 00:21:14.999
And that\'s going to be a major … if
that gets enforced by the doctor

00:21:15.000 --> 00:21:19.999
who I guess has the ultimate word

00:21:20.000 --> 00:21:24.999
is going to be devastating. It\'s my home
town. I like to go Cardinals games there.

00:21:25.000 --> 00:21:29.999
I have friends and a few
relatives around there.

00:21:30.000 --> 00:21:34.999
I\'ve become part of larger groups

00:21:35.000 --> 00:21:39.999
for certain special occasions. I have an
appointment with the doctor from the sixth.

00:21:40.000 --> 00:21:44.999
I\'m sort of …

00:21:45.000 --> 00:21:49.999
I just thought about
calling him a little bit.

00:21:50.000 --> 00:21:54.999
But then I thought, well,
maybe he\'s decided to,

00:21:55.000 --> 00:21:59.999
but he\'s going to tell me in
person and I\'d rather hear it in

00:22:00.000 --> 00:22:04.999
person I think and I didn\'t
want to precipitate it.

00:22:05.000 --> 00:22:09.999
Like, okay, yeah. Don\'t drive down there.

00:22:10.000 --> 00:22:14.999
Any other new medical problems?

00:22:15.000 --> 00:22:19.999
No. No. So, you\'ve been healthy? Yeah,
except for I don\'t eat very well, but …

00:22:20.000 --> 00:22:24.999
You said that your appetite was okay. Oh, my appetite
is good. I just don\'t eat the most healthy food.

00:22:25.000 --> 00:22:29.999
Oh, I see. So, Margaret let\'s
do a few thinking tests,

00:22:30.000 --> 00:22:34.999
all right. Let\'s just do that and then we\'ll talk about
all the rest of the questions afterwards, all right.

00:22:35.000 --> 00:22:39.999
So, uh… you know the drill. I\'m just going
to ask you a few questions just humor me

00:22:40.000 --> 00:22:44.999
and we\'ll get through it, all right. Tell me where you are
right now. I\'m at North Western Memorial on the 20th floor.

00:22:45.000 --> 00:22:49.999
And what season is it? Fall.

00:22:50.000 --> 00:22:54.999
Good. And what city are we in? Chicago And
what state? Illinois. And what county? Cook.

00:22:55.000 --> 00:22:59.999
Good. And I\'m going to ask
you to remember words, okay?

00:23:00.000 --> 00:23:04.999
The words are apple, penny and table.
Can you repeat those?

00:23:05.000 --> 00:23:09.999
Apple, penny, table. Say them again? Apple, penny,
table. Good. Remember those when I ask you them.

00:23:10.000 --> 00:23:14.999
Special the word world for me?

00:23:15.000 --> 00:23:19.999
W-O-R-L-D. And now backwards?

00:23:20.000 --> 00:23:24.999
D-L-R-O …

00:23:25.000 --> 00:23:29.999
I don\'t remember the last one.
Take your time.

00:23:30.000 --> 00:23:34.999
Okay. World backwards was it?
Mm-hmm. Spell it again?

00:23:35.000 --> 00:23:39.999
[sil.]

00:23:40.000 --> 00:23:44.999
Okay, could I like …? No.

00:23:45.000 --> 00:23:49.999
Okay. Spell it forwards
again if you need to.

00:23:50.000 --> 00:23:54.999
No, I can even do … okay.

00:23:55.000 --> 00:23:59.999
Why don\'t we move on and we\'ll come back
if we need to? Okay. What this called?

00:24:00.000 --> 00:24:04.999
Watch. And what\'s – what do I
have in my hand here? Pen.

00:24:05.000 --> 00:24:09.999
All right. And repeat after me. No ifs,
ands or buts. No ifs, ands or buts.

00:24:10.000 --> 00:24:14.999
Good. Do you remember those words that
I asked you to keep in your head?

00:24:15.000 --> 00:24:19.999
Apple. Yes, that\'s good.

00:24:20.000 --> 00:24:24.999
Any of the others?

00:24:25.000 --> 00:24:29.999
All right, okay. I\'m going to ask you to
do three things with this piece of paper.

00:24:30.000 --> 00:24:34.999
And do them after I say go.

00:24:35.000 --> 00:24:39.999
Pick up the paper with your right hand, fold it
in half once and give it to Jessie. Go ahead.

00:24:40.000 --> 00:24:44.999
[sil.]

00:24:45.000 --> 00:24:49.999
Okay. I\'ll take it back. Now, we\'re a little
constrained here because we don\'t have a desk.

00:24:50.000 --> 00:24:54.999
But I\'m going to give you this.
Here\'s a pen. Okay.

00:24:55.000 --> 00:24:59.999
Read what this says. Okay, yes. Yes.
Read it out loud so I can hear it.

00:25:00.000 --> 00:25:04.999
Close your eyes. Good. And now
make a copy of this picture. Okay.

00:25:05.000 --> 00:25:09.999
[sil.]

00:25:10.000 --> 00:25:14.999
Let\'s see. Good,

00:25:15.000 --> 00:25:19.999
great. So, you did pretty well.

00:25:20.000 --> 00:25:24.999
Even though you had trouble with
world, your total score was 27

00:25:25.000 --> 00:25:29.999
and that\'s exactly the same as last time.
All right.

00:25:30.000 --> 00:25:34.999
So, we consider stability is a good thing. Yeah. Yeah.
And that\'s what we want to see. So, let\'s go over

00:25:35.000 --> 00:25:39.999
some of the other questions and talk about some of the other issues?
Okay. Today. I\'m not ready to talk about the driving issues.

00:25:40.000 --> 00:25:44.999
Yeah, all right. So, did you –
you\'ve got a copy of the report.

00:25:45.000 --> 00:25:49.999
I understand. Did you read through it?
What were your thoughts?

00:25:50.000 --> 00:25:54.999
Well … I know you have a whole lot of thoughts
here, but … Yes, I do. We\'ll go back to those.

00:25:55.000 --> 00:25:59.999
What are your thoughts or what was your understanding
of what they said? Well, my understanding was

00:26:00.000 --> 00:26:04.999
if they don\'t want me driving
by myself down to Saint Louis.

00:26:05.000 --> 00:26:09.999
Why? What did they say?

00:26:10.000 --> 00:26:14.999
I don\'t remember that. Okay. And how do
think you did on the driving evaluation?

00:26:15.000 --> 00:26:19.999
[sil.]

00:26:20.000 --> 00:26:24.999
Well, I don\'t exactly know

00:26:25.000 --> 00:26:29.999
how to evaluate it from
the perspective of –

00:26:30.000 --> 00:26:34.999
what the outcome is going to be, you know.
I mean did you think about well for you,

00:26:35.000 --> 00:26:39.999
did you get where you needed to go or did they correct you a
lot? I mean what was your sort of your feeling during the test?

00:26:40.000 --> 00:26:44.999
Well, for the most part, I felt fairly good.
Did it seem like a fair test that they …?

00:26:45.000 --> 00:26:49.999
Yeah. Did they use your car or their car?
Their car.

00:26:50.000 --> 00:26:54.999
They noticed a couple of things that

00:26:55.000 --> 00:26:59.999
uh… just a little that they mentioned to me
that may have been a little bit concerning.

00:27:00.000 --> 00:27:04.999
You were at times a little inconsistent in
your performance. So, if you got distracted,

00:27:05.000 --> 00:27:09.999
you might, you know, move in the lane
a little bit or you might slow down,

00:27:10.000 --> 00:27:14.999
but not appropriately slow down in traffic. You might
just slow down on your own because you\'d be talking.

00:27:15.000 --> 00:27:19.999
So, what their suggestion was – that\'s
what we\'re going to talk about is that so

00:27:20.000 --> 00:27:24.999
because you\'re a little bit
inconsistent between the two times

00:27:25.000 --> 00:27:29.999
and because there was a history where
you had gotten lost, I think before

00:27:30.000 --> 00:27:34.999
that umm… they recommended
that uh… if you drive,

00:27:35.000 --> 00:27:39.999
uh… that would be okay, but with a couple of restrictions.
And that was their suggestion. One restriction was that

00:27:40.000 --> 00:27:44.999
you should drive to local and … you know, if you\'re going to
drive, it should be only to local and familiar places, okay.

00:27:45.000 --> 00:27:49.999
They had some concerns

00:27:50.000 --> 00:27:54.999
about your driving to Saint Louis. And I said
say that based on the report, they obviously …

00:27:55.000 --> 00:27:59.999
the test wasn\'t to have you drive to Saint Louis.
So, they didn\'t test your driving to Saint Louis.

00:28:00.000 --> 00:28:04.999
But based on your history, they\'re
making a suggestion about that.

00:28:05.000 --> 00:28:09.999
Jessie, have you driven with Margaret?
Yes. And uh… recently?

00:28:10.000 --> 00:28:14.999
Yes, probably about a week
and a half ago, I think. In?

00:28:15.000 --> 00:28:19.999
In Saint Louis – I\'m so stuck on this thing.
Just from her apartment, we went up to church

00:28:20.000 --> 00:28:24.999
and had dinner up there for that speak of that
time. And so – And then there was the time

00:28:25.000 --> 00:28:29.999
when we shared driving back from Calvin.

00:28:30.000 --> 00:28:34.999
That was last … that was in June
and you drove a little bit.

00:28:35.000 --> 00:28:39.999
Yeah, so she seems to be doing
really pretty well, I think.

00:28:40.000 --> 00:28:44.999
I felt fine. You felt comfortable. I felt okay.
Okay. I guess I\'m little more on edge just

00:28:45.000 --> 00:28:49.999
because I know, you know all
that\'s going on. But I felt …

00:28:50.000 --> 00:28:54.999
I mean, it was … she did a great job
and she turned left out of a gas,

00:28:55.000 --> 00:28:59.999
we stopped and got gas and she turned
left into – you know, on to a road …

00:29:00.000 --> 00:29:04.999
busy and did that fine. And paid attention to
the traffic? And paid attention to the traffic.

00:29:05.000 --> 00:29:09.999
All right. And uh… so, that\'s great. I\'m
glad to hear that. And umm… it\'s uh…

00:29:10.000 --> 00:29:14.999
you have a list here of things. Did you do this list on
your own or do you – or did you talk about it with someone?

00:29:15.000 --> 00:29:19.999
Well, I have to tell you, I\'m impressed
with the list because uh… it demonstrates

00:29:20.000 --> 00:29:24.999
uh… some thoughtfulness, I
think about the issues.

00:29:25.000 --> 00:29:29.999
And umm… let\'s talk about a couple of things. So, Saint Louis
is a straight trip and you\'ve made it many times before?

00:29:30.000 --> 00:29:34.999
I do it all the time. What\'s in Saint Louis again
that\'s so important? Well, it\'s my hometown

00:29:35.000 --> 00:29:39.999
and it\'s where I go … I do sort of most of my
vacation time is because I have friends down there

00:29:40.000 --> 00:29:44.999
who I also – we also went to school
with – or one of them I went to school.

00:29:45.000 --> 00:29:49.999
So, when you\'re going to Saint Louis,
you just go there and go to your house

00:29:50.000 --> 00:29:54.999
and no one sees you or …? No, I go and go to
their house. Okay. And they\'re there. And …

00:29:55.000 --> 00:29:59.999
So, you would be … people would
know you\'re coming. Yes.

00:30:00.000 --> 00:30:04.999
And would be expecting. And
you\'ll see that that. I let you …

00:30:05.000 --> 00:30:09.999
Yes, okay. Uh… all right. So, people would know
you\'re coming and would expect you to arrive.

00:30:10.000 --> 00:30:14.999
And do they know when you leave Chicago?

00:30:15.000 --> 00:30:19.999
Umm… I\'m starting to get
to where I do that, yes.

00:30:20.000 --> 00:30:24.999
I really like your suggestion
about the cell phone.

00:30:25.000 --> 00:30:29.999
Umm… and do the people who expect you in Saint
Louis, do they have your cell phone number?

00:30:30.000 --> 00:30:34.999
I\'m not sure if they have mine. Right.
So, that would be important.

00:30:35.000 --> 00:30:39.999
So, give out cell

00:30:40.000 --> 00:30:44.999
phone number to friends; friends
here and friends there.

00:30:45.000 --> 00:30:49.999
Yes. Did you write that in there?
I did, yeah. Okay.

00:30:50.000 --> 00:30:54.999
Friends here and in Saint Louis, okay.

00:30:55.000 --> 00:30:59.999
And then umm… okay.

00:31:00.000 --> 00:31:04.999
And then uh… you have a whole discussion about
the various rest stops. I think umm… you know,

00:31:05.000 --> 00:31:09.999
for now I would probably be okay with
you continuing to drive to Saint Louis

00:31:10.000 --> 00:31:14.999
because you have a lot of good plans here.
And umm… I think

00:31:15.000 --> 00:31:19.999
uh… a good sense of some of the difficulties and that you\'ve
– you really do demonstrate you\'ve thought through this.

00:31:20.000 --> 00:31:24.999
What I would like to have you make sure is
that you tell people when you\'re leaving,

00:31:25.000 --> 00:31:29.999
people here is fine, but the people
in Saint Louis will be important.

00:31:30.000 --> 00:31:34.999
I want to make sure that you start out in the early
morning. So, if it takes a few hours to get to Saint Louis

00:31:35.000 --> 00:31:39.999
that you\'re not arriving when it\'s dark. The
phone should always be on when you\'re driving.

00:31:40.000 --> 00:31:44.999
Don\'t talk on the phone while you\'re driving. And this is something
we\'re going to have the periodically rethink about, revaluate.

00:31:45.000 --> 00:31:49.999
You\'re changing, but you\'ve
been pretty stable this time

00:31:50.000 --> 00:31:54.999
and I\'m comfortable with
saying you can continue that.

00:31:55.000 --> 00:31:59.999
Good. Anything else?

00:32:00.000 --> 00:32:04.999
No. No. You\'re happy? Oh, yeah.

00:32:05.000 --> 00:32:10.000
All right. So, I\'m glad to – I\'m glad to
be able to say that. I think you did okay.

00:32:25.000 --> 00:32:29.999
Michael was driving umm… up
until Christmas Eve last year.

00:32:30.000 --> 00:32:34.999
I tried to so-called wean him from driving.

00:32:35.000 --> 00:32:39.999
Umm… I was told that he\'s on the medicine

00:32:40.000 --> 00:32:44.999
and he … it\'s possible that

00:32:45.000 --> 00:32:49.999
it\'s okay to drive for awhile, but then you should
… he should not be driving after a certain point.

00:32:50.000 --> 00:32:54.999
I would drive with him. He seemed to
drive to okay. He was driving slow.

00:32:55.000 --> 00:32:59.999
But, I thought that was fine. He\'d only go a mile
away if he went to the store and he was like Mr. Mum,

00:33:00.000 --> 00:33:04.999
he did the errands for me. He went to the cleaners;
he went to the grocery store or whatever.

00:33:05.000 --> 00:33:09.999
That was not a problem to me. I
figured it was only a mile away.

00:33:10.000 --> 00:33:14.999
Christmas Eve last year, I had went out
uh… to my girl friend\'s for a short time.

00:33:15.000 --> 00:33:19.999
He took the car … his car

00:33:20.000 --> 00:33:24.999
and umm… crashed it into a tree.
That was the end of his driving.

00:33:25.000 --> 00:33:29.999
He feels that the driving…

00:33:30.000 --> 00:33:34.999
driving for him is his only
independence that he had left.

00:33:35.000 --> 00:33:39.999
He\'s dependent on me for everything. And
this was the last of his independence.

00:33:40.000 --> 00:33:44.999
Umm… when this happened, I told him that

00:33:45.000 --> 00:33:49.999
a little white lie that the insurance dropped
him to the fact you have Alzheimer\'s

00:33:50.000 --> 00:33:54.999
and can no longer drive. Um…
he broke down and cried.

00:33:55.000 --> 00:33:59.999
He was umm… for probably
about three, four days,

00:34:00.000 --> 00:34:04.999
he was very sad, very to himself.

00:34:05.000 --> 00:34:09.999
Then unfortunately four days passed and
he forgot that he crashed the car.

00:34:10.000 --> 00:34:14.999
See – and this is more or less
an ongoing thing. It really is.

00:34:15.000 --> 00:34:19.999
No matter how you try to wean them
from driving, stop having them drive,

00:34:20.000 --> 00:34:24.999
this is a problem I find.
And in the support group,

00:34:25.000 --> 00:34:29.999
the other uh… visitors there
have the same problem,

00:34:30.000 --> 00:34:34.999
that you could take the keys away.
I disengage the battery

00:34:35.000 --> 00:34:39.999
so the car wouldn\'t work and I\'ll be
darned he knew how to – he just knows.

00:34:40.000 --> 00:34:44.999
Actually he was a step ahead
of me on that I think.

00:34:45.000 --> 00:34:49.999
But he put the – he connected the
cables and away he went again.

00:34:50.000 --> 00:34:54.999
And to this day, he still wants to drive.

00:34:55.000 --> 00:34:59.999
Now you had mentioned earlier that you also took the keys.
You mean, literally you took the keys and hid them.

00:35:00.000 --> 00:35:04.999
Yes, I wouldn\'t even leave
my keys around to my car

00:35:05.000 --> 00:35:09.999
because I was afraid that he\'d pick
them up. So, I had to hide my keys.

00:35:10.000 --> 00:35:14.999
He\'ll tell me … he goes, I
have this terrible disease

00:35:15.000 --> 00:35:19.999
and I really hate it. I hate living.
He\'ll say that once in a while

00:35:20.000 --> 00:35:24.999
because I cannot drive. In fact, every time
he goes to the doctor for his check up

00:35:25.000 --> 00:35:29.999
and he will ask doctor, can I drive.
He\'ll bring it up.

00:35:30.000 --> 00:35:34.999
He\'ll say, I need to the doctor alone and
the doctor understands. So, he says,

00:35:35.000 --> 00:35:39.999
Michael, at this time, I don\'t feel that you
can drive. Remember, you\'re on medication.

00:35:40.000 --> 00:35:44.999
And he\'ll go, okay. And (inaudible)

00:35:45.000 --> 00:35:49.999
he doesn\'t get mad, doesn\'t get angry.
Umm… does not get mad at me

00:35:50.000 --> 00:35:54.999
on the way back from the doctor. So, it\'s accepted
that the doctor … whatever the doctor says goes.

00:35:55.000 --> 00:35:59.999
Every Alzheimer\'s person is unique.

00:36:00.000 --> 00:36:04.999
You don\'t know what will work.
What may work for one person

00:36:05.000 --> 00:36:09.999
may not work for you. And you have
test out all these different uh… ways.

00:36:10.000 --> 00:36:14.999
And yes, the advice is given to you

00:36:15.000 --> 00:36:20.000
umm… to try different things and you do it, you see what
works for you because again, every person is different.

00:36:35.000 --> 00:36:39.999
I had talked to a Dr. Palmer
(inaudible), that\'s my mom\'s doctor

00:36:40.000 --> 00:36:44.999
and umm… told him what I was
experiencing with my mom\'s,

00:36:45.000 --> 00:36:49.999
you know in emotions so on. And he says,
well why don\'t you make an appointment

00:36:50.000 --> 00:36:54.999
at the Rush Alzheimer\'s Center and
I\'ll do – they\'ll do some testing

00:36:55.000 --> 00:36:59.999
and then we\'ll know where we stand, you know
and what we need to do if she has something

00:37:00.000 --> 00:37:04.999
we can help her out. So, that\'s what we
did. We went there morning and of course

00:37:05.000 --> 00:37:09.999
I wasn\'t in there when there were testing her. And
umm… so, then I meet with the doctor afterwards

00:37:10.000 --> 00:37:14.999
and she said … she was
telling me, you know,

00:37:15.000 --> 00:37:19.999
that she felt my mom was having some difficulty
in the cognitive skills and that she felt

00:37:20.000 --> 00:37:24.999
that she shouldn\'t be living alone
anymore and she shouldn\'t be driving.

00:37:25.000 --> 00:37:29.999
I was so upset that day that uh…
I just – I was all mad and angry

00:37:30.000 --> 00:37:34.999
that the ladies at the – we\'re
taking your car away from you.

00:37:35.000 --> 00:37:39.999
And I was wondering you take my car – because
you\'re not – you didn\'t pass the test,

00:37:40.000 --> 00:37:44.999
you didn\'t do this, you didn\'t do that.
I was ready to walk out, believe me.

00:37:45.000 --> 00:37:49.999
I was going to tell them to go to … somewhere. I
don\'t know what they based their decision at.

00:37:50.000 --> 00:37:54.999
Umm… they did show me some of the
things that they tested my mom on.

00:37:55.000 --> 00:37:59.999
One was a clock and they
asked her – it was a round,

00:38:00.000 --> 00:38:04.999
circle and they showed her a picture of a clock and
asked her to draw the numbers around the clock.

00:38:05.000 --> 00:38:09.999
And she had the numbers all
on one side of the clock.

00:38:10.000 --> 00:38:14.999
And then she started filling up the other – started the
numbers all over again. So, they felt that there\'s some…

00:38:15.000 --> 00:38:19.999
They\' don\'t explain it right …

00:38:20.000 --> 00:38:24.999
So, you know, I mean … (inaudible) When you
don\'t understand the medical part of it,

00:38:25.000 --> 00:38:29.999
you just see the physical part of it

00:38:30.000 --> 00:38:34.999
and you just see that everything
seems to be somewhat normal

00:38:35.000 --> 00:38:39.999
and it doesn\'t seem like
there\'s a real severe problem.

00:38:40.000 --> 00:38:44.999
So, you know, I just … I don\'t know
what the next step is going to be.

00:38:45.000 --> 00:38:49.999
Like I said, I just hope that, you know, my
mom would be honest with me and herself.

00:38:50.000 --> 00:38:54.999
I take my time. I don\'t speed; I don\'t do
anything like that. So, I watch the roads

00:38:55.000 --> 00:38:59.999
and watch the signs and everything. So, I
just figured I\'m okay. I watch the traffic.

00:39:00.000 --> 00:39:04.999
There are some idiots on the road, I understand that.
But you\'ve got to watch it. Okay, just be careful.

00:39:05.000 --> 00:39:09.999
We just heard about these
people that run into the people

00:39:10.000 --> 00:39:14.999
and they step on the gas pedal instead of the break. So,
you know, this all was going through my mind thinking,

00:39:15.000 --> 00:39:19.999
okay, if my mom gets in a situation

00:39:20.000 --> 00:39:24.999
where she gets upset about something and she\'s thinking she\'s
going to step on the break and she steps and the gas pedal,

00:39:25.000 --> 00:39:29.999
you know, somehow I feel
a little responsible,

00:39:30.000 --> 00:39:34.999
you know, to make a decision because

00:39:35.000 --> 00:39:39.999
I know what they\'ve said
and what should be done;

00:39:40.000 --> 00:39:44.999
yet, I don\'t understand it when I see
that my mom seems to be doing okay.

00:39:45.000 --> 00:39:49.999
I was mad at her. I was mad at them.

00:39:50.000 --> 00:39:54.999
Uh… I said I might go and kill myself.
That\'s the way I felt.

00:39:55.000 --> 00:39:59.999
I – right then, I think I shot myself.
That\'s how bad I felt.

00:40:00.000 --> 00:40:04.999
I was … needless to say, it was
very emotional from me as well.

00:40:05.000 --> 00:40:09.999
I felt bad from my mom

00:40:10.000 --> 00:40:14.999
and I just felt that

00:40:15.000 --> 00:40:19.999
she didn\'t trust me. No. To
help her to do the right thing.

00:40:20.000 --> 00:40:24.999
And I mean I\'m an only child and I\'ve
been there for my mother all the time.

00:40:25.000 --> 00:40:29.999
I\'ve helped her through many situations

00:40:30.000 --> 00:40:34.999
and I said mom, you know, why would I
want to hurt you, why would I do this

00:40:35.000 --> 00:40:39.999
to – to hurt you. And then
she apologized to me.

00:40:40.000 --> 00:40:44.999
She said, no, I know, you
know, that you care about me.

00:40:45.000 --> 00:40:49.999
But she was hurt and angry and of
course, who do you take it out on,

00:40:50.000 --> 00:40:54.999
the person that\'s closest to you.
So, I just –

00:40:55.000 --> 00:40:59.999
it was very hard for me as well because,
you know, nobody likes to see their –

00:41:00.000 --> 00:41:04.999
their parent go through any
difficult time. Yeah ah…

00:41:05.000 --> 00:41:09.999
And uh… you know, it\'s – it\'s very
difficult because you don\'t know

00:41:10.000 --> 00:41:14.999
what\'s the right thing to do. We had considered
going to the driver\'s test that they offer.

00:41:15.000 --> 00:41:19.999
It\'s – I guess it\'s a
cognitive test of some sort

00:41:20.000 --> 00:41:24.999
and it\'s by an occupational therapist.

00:41:25.000 --> 00:41:29.999
And unfortunately, there\'s no funds with Medicare
or anything to cover the cost of this test.

00:41:30.000 --> 00:41:34.999
It\'s like $500 to take this test.
And my mom was getting

00:41:35.000 --> 00:41:39.999
real upset about having to spend $500
to be told she can\'t drive anymore.

00:41:40.000 --> 00:41:44.999
So, uh… you know, and she was getting very
nervous and emotionally distraught over it.

00:41:45.000 --> 00:41:49.999
So, I just canceled the test.
I couldn\'t fight it.

00:41:50.000 --> 00:41:54.999
I just had to say, we\'re
not taking the test.

00:41:55.000 --> 00:42:00.000
You just umm… go about doing what you\'re
doing if you feel like you can still drive.

00:42:05.000 --> 00:42:09.999
In Alzheimer\'s disease, even in early Alzheimer\'s
disease, there is a change in the ability

00:42:10.000 --> 00:42:14.999
to pay attention to your surroundings.
And most of us are not aware of the fact

00:42:15.000 --> 00:42:19.999
that we have what\'s called a window of the attention.
So, even if you\'re staring straight ahead,

00:42:20.000 --> 00:42:24.999
you can pay attention to things that are in either
side of you without moving your eyes at all.

00:42:25.000 --> 00:42:29.999
As people get older, that
attention window narrows

00:42:30.000 --> 00:42:34.999
so that in order to pay attention to the
things on the side, you have to look at them.

00:42:35.000 --> 00:42:39.999
So, you have to divert your eyes away from the
center. Young people can keep their eyes fixated

00:42:40.000 --> 00:42:44.999
in the center of the road and pay
attentions to anything going on

00:42:45.000 --> 00:42:49.999
in the periphery whereas older people
can\'t. In Alzheimer\'s diseases,

00:42:50.000 --> 00:42:54.999
that is exaggerated, that inability to attend
to things that are happening on the side.

00:42:55.000 --> 00:42:59.999
Reaction time slows in
Alzheimer\'s diseases as well.

00:43:00.000 --> 00:43:04.999
There is an age related decline in reaction time.
But it\'s even more exaggerated in Alzheimer\'s.

00:43:05.000 --> 00:43:09.999
So, your ability to react quickly to
something that happens that\'s unexpected

00:43:10.000 --> 00:43:14.999
will change as well.

00:43:15.000 --> 00:43:19.999
Uh… there is parts of the brain that control visual
perception. For example, your ability to back your car

00:43:20.000 --> 00:43:24.999
into a parking space where your brain
is doing all types of computations

00:43:25.000 --> 00:43:29.999
about the size of your car, the
angle at which you\'re backing in.

00:43:30.000 --> 00:43:34.999
It has nothing to do with short term memory.
It\'s a completely different system in the brain.

00:43:35.000 --> 00:43:39.999
But it does become affected as the
diseases moves towards those areas.

00:43:40.000 --> 00:43:44.999
So, then your maybe incapable of judging
space and you may sideswipe a car

00:43:45.000 --> 00:43:49.999
because you can\'t figure out that
your car takes so much space.

00:43:50.000 --> 00:43:54.999
I started feeling uncomfortable driving.

00:43:55.000 --> 00:43:59.999
Uh… I felt that uh…

00:44:00.000 --> 00:44:04.999
that I wasn\'t quite with it all. That I wasn\'t quite
with it all. That\'s – I – suddenly it would go by me

00:44:05.000 --> 00:44:09.999
and I – where I wouldn\'t see it, uh… because
like, I was going to turn into another lane

00:44:10.000 --> 00:44:14.999
and I – I\'ve always looked, religiously
looked and then all of a sudden I hear a honk

00:44:15.000 --> 00:44:19.999
and I was over the lane. So, it\'s the

00:44:20.000 --> 00:44:24.999
uh… I think the depth perception a lot
from my eyes has made a big difference.

00:44:25.000 --> 00:44:29.999
And uh… so, I\'ve just decided that
uh… I had to be very careful.

00:44:30.000 --> 00:44:34.999
And with the vision aspect, I just probably – I mean you tell me. But I
think it\'s more the vision that is affecting you more than anything else

00:44:35.000 --> 00:44:39.999
where that part of the brain

00:44:40.000 --> 00:44:44.999
that processes what you see for Marty is what
slowed down. So, it\'s the delayed reaction.

00:44:45.000 --> 00:44:49.999
You know, something will come across, his eyes see,
but it\'s maybe two or three seconds before registers.

00:44:50.000 --> 00:44:54.999
And that\'s the part that\'s dangerous
from the driving standpoint for him.

00:44:55.000 --> 00:44:59.999
I often tell us spouses, if you want to
get a firsthand assessment of roughly

00:45:00.000 --> 00:45:04.999
how well they\'re going to do, just ride with them.
You know, do you feel comfortable riding with them?

00:45:05.000 --> 00:45:09.999
And sometimes I also make it more personal. Would you ride – would
you put your grandchild in the back seat when they\'re driving?

00:45:10.000 --> 00:45:14.999
If the answer to that is no, then I remind
them that someone else\'s grandchild is riding

00:45:15.000 --> 00:45:19.999
in some other car and just because you\'re not in that
car doesn\'t mean they won\'t be involved in a crash.

00:45:20.000 --> 00:45:24.999
Looking back on own career,
I\'ve got to say that

00:45:25.000 --> 00:45:29.999
I probably have not been quite as …
what should I say, as proactive about

00:45:30.000 --> 00:45:34.999
uh… taking away the car keys and
recommending taking away the car keys

00:45:35.000 --> 00:45:39.999
and what have you as I should have.

00:45:40.000 --> 00:45:44.999
Uh… so that it\'s only in the last
few years that I\'ve really become,

00:45:45.000 --> 00:45:49.999
as they say, very, very active about this.
What has uh… caused that changed?

00:45:50.000 --> 00:45:54.999
Oh, just the data. I mean the
data is quite clear that… that

00:45:55.000 --> 00:46:00.000
uh… people even with mild to moderate
impairment frequently should not be driving.

00:46:05.000 --> 00:46:09.999
It\'s very hard for us as
health care providers

00:46:10.000 --> 00:46:14.999
to say to a patient, well, you can\'t drive anymore
because you have early Alzheimer\'s disease.

00:46:15.000 --> 00:46:19.999
It\'s not necessarily true that

00:46:20.000 --> 00:46:24.999
just because you have early Alzheimer\'s disease
that you shouldn\'t drive. In some individuals,

00:46:25.000 --> 00:46:29.999
the ability to drive maybe preserved
for a few months or a couple of years

00:46:30.000 --> 00:46:34.999
before others symptoms begin to
affect driving. And it\'s very hard

00:46:35.000 --> 00:46:39.999
to make an arbitrary decision and say you
shouldn\'t… you shouldn\'t be driving.

00:46:40.000 --> 00:46:44.999
And so, what we do in our clinical
practice is to recommend that

00:46:45.000 --> 00:46:49.999
the individual undergo a
formal driving evaluation.

00:46:50.000 --> 00:46:54.999
The typical test that\'s done by most registries of
motor vehicles when you go to renew your licenses

00:46:55.000 --> 00:46:59.999
really doesn\'t get at the issues that affect
individuals with Alzheimer\'s disease.

00:47:00.000 --> 00:47:04.999
You typically get a test of your eyes sight

00:47:05.000 --> 00:47:09.999
which in most people who have Alzheimer\'s disease is not
effected, really. It\'s a perception and not sight itself.

00:47:10.000 --> 00:47:14.999
There are driving evaluation programs

00:47:15.000 --> 00:47:19.999
around the country that are typically
offered by rehabilitation facilities.

00:47:20.000 --> 00:47:24.999
Uh… a lot of times, these are geared
towards individuals who\'ve had a stroke

00:47:25.000 --> 00:47:29.999
and may have motor problems when they\'re
driving as opposed to cognitive problems.

00:47:30.000 --> 00:47:34.999
But more and more of these programs are understanding
that cognitive deficits can have an impact on driving

00:47:35.000 --> 00:47:39.999
to as great an extent as motor deficits

00:47:40.000 --> 00:47:44.999
and begin to pay attention to those things.
The evaluation will consists of

00:47:45.000 --> 00:47:49.999
questions about traffic rules, may consist
of a brief series of tests of reaction time,

00:47:50.000 --> 00:47:54.999
how quickly you can respond to
changing lights for example

00:47:55.000 --> 00:47:59.999
and then an actual drive in the car,
taking somebody out on the road

00:48:00.000 --> 00:48:04.999
and having them do a series of maneuvers

00:48:05.000 --> 00:48:10.000
to actually see how do they
perform in a such a situation.

00:48:15.000 --> 00:48:19.999
They often equate the…

00:48:20.000 --> 00:48:24.999
the news regarding the need to stop
driving as being even more negative

00:48:25.000 --> 00:48:29.999
than receiving the diagnosis of dementia.

00:48:30.000 --> 00:48:34.999
So, the first major safety issue that you have to deal and
you have to confront relatively early and it\'s difficult

00:48:35.000 --> 00:48:39.999
because that means you\'re probably not established as much a
relationship with the patient as you will have later in the course.

00:48:40.000 --> 00:48:44.999
So, for us later in the course of the disease
after issues around using the kitchen safely

00:48:45.000 --> 00:48:49.999
or uh… you know, wandering outside the
house, you have an established relationship

00:48:50.000 --> 00:48:54.999
and it\'s a little bit easier to take a challenge – to confront
those things. But when you\'re just meeting someone to say

00:48:55.000 --> 00:48:59.999
the end of the first visit or the second visit, oh, by the way, I really
don\'t think it\'s safe for you to drive anymore. That\'s a real challenge.

00:49:00.000 --> 00:49:04.999
Well, physicians don\'t
want to break bad news

00:49:05.000 --> 00:49:09.999
and this is bad news. And it\'s hard for
us to do this. Uh… families get angry.

00:49:10.000 --> 00:49:14.999
Patients are upset. And uh… it\'s
a very difficult thing to do.

00:49:15.000 --> 00:49:19.999
And you\'re concerned about
your patient also because

00:49:20.000 --> 00:49:24.999
once they\'re not able to as mobile as they
used to be, uh… if they\'re not able to drive

00:49:25.000 --> 00:49:29.999
uh… what are the consequences to the patient and…
and the families? There\'s a huge implications

00:49:30.000 --> 00:49:34.999
to lifestyle changes for… for families
and we\'re concerned about that.

00:49:35.000 --> 00:49:39.999
If it\'s at all possible in
the … if a patient is been

00:49:40.000 --> 00:49:44.999
examined very early on in the course of symptoms to
bring up the issue of driving because even though

00:49:45.000 --> 00:49:49.999
they may still be safe to drive at the time that you
see them, there\'s definitely going to come a point

00:49:50.000 --> 00:49:54.999
at which they will no longer be safe
to drive. And getting them involved

00:49:55.000 --> 00:49:59.999
at the initial stages when they\'re still capable of
understanding the potential dangers of continuing to drive,

00:50:00.000 --> 00:50:04.999
it would be a good idea to
work with the individual

00:50:05.000 --> 00:50:09.999
with family or families available
to come up with a plan

00:50:10.000 --> 00:50:14.999
that can unfold slowly. Uh… driving is a
major sign of autonomy in our country.

00:50:15.000 --> 00:50:20.000
And most people have a very difficult …
understandably difficult time giving it up.

00:50:25.000 --> 00:50:29.999
The whole process of allowing
them to come together

00:50:30.000 --> 00:50:34.999
and share their feelings and to recognize
that other people are in the same situation

00:50:35.000 --> 00:50:39.999
and the support that they…
they receive from the group

00:50:40.000 --> 00:50:44.999
is really beneficial in helping them work
through those negative emotions associated

00:50:45.000 --> 00:50:49.999
with the lost of their driving privileges. And one
of the things that we have found to be effective

00:50:50.000 --> 00:50:54.999
is to constantly emphasize
to the participants

00:50:55.000 --> 00:50:59.999
that it\'s the illness that has
robbed them of their abilities

00:51:00.000 --> 00:51:04.999
and uh… often they will see the revocation of
their driving privileges as being age based.

00:51:05.000 --> 00:51:09.999
And we constantly reinforced
that it\'s not age

00:51:10.000 --> 00:51:14.999
that has resulted or triggered
the loss of driving privileges,

00:51:15.000 --> 00:51:20.000
but rather it\'s the illness and the illness
has affected their ability to drive.

00:51:25.000 --> 00:51:29.999
Although we\'re not mandated to report – we\'re
legally allowed to report as is actually anyone,

00:51:30.000 --> 00:51:34.999
any citizen in Massachusetts. I write letters saying as we
discussed at your last appointment because of your memory problem,

00:51:35.000 --> 00:51:39.999
I no longer thing it\'s safe for you to drive and
then I just sign it and put it on letter head.

00:51:40.000 --> 00:51:45.560
I\'m sure a lot of families have it framed or put it up on the refrigerator.
And I think it at times helps; at least they say that it helps.

00:51:50.000 --> 00:51:54.999
I asked a doctor to write a
note because periodically

00:51:55.000 --> 00:51:59.999
he would say he wants a car.
And when he wrote the note

00:52:00.000 --> 00:52:04.999
and he told him that he can
no … he can\'t drive right now

00:52:05.000 --> 00:52:09.999
and he kept the note on his dresser

00:52:10.000 --> 00:52:14.999
so he would see it every day and he\'d pick
it up and read it or try to read the words.

00:52:15.000 --> 00:52:20.000
And umm… being in front of him
that… that sufficed for a while.

00:52:25.000 --> 00:52:29.999
Typically, for people living in the
city, the Department on ageing

00:52:30.000 --> 00:52:34.999
maybe able to provide transportation. Uh… there
maybe taxi vouchers that an individual could use.

00:52:35.000 --> 00:52:39.999
There are many options that uh…
and families may have a hard time

00:52:40.000 --> 00:52:44.999
locating those resources on their own. So,
usually it would good to refer somebody to

00:52:45.000 --> 00:52:49.999
uh… the department on ageing or some other
institution that deals with seniors

00:52:50.000 --> 00:52:54.999
and maybe able to provide some
guidance about alternates.

00:52:55.000 --> 00:52:59.999
A very big problem arises in
rural communities where we only

00:53:00.000 --> 00:53:04.999
mode of transportation are the wheels.

00:53:05.000 --> 00:53:09.999
And people might be quite isolated if they can no longer
drive. And that\'s a very difficult issue to deal with.

00:53:10.000 --> 00:53:14.999
What we\'ve developed a here is

00:53:15.000 --> 00:53:19.999
uh… a services manual
for alternatives that …

00:53:20.000 --> 00:53:24.999
alternatives to transportation – rather
than an alternative transportation.

00:53:25.000 --> 00:53:29.999
Some level of transport
services ranging from

00:53:30.000 --> 00:53:34.999
dental services to beauticians
to drug stores to shopping so on

00:53:35.000 --> 00:53:39.999
that could be brought into the home
to substitute for transportation.

00:53:40.000 --> 00:53:44.999
Now that kind of a manual will differ
for every different community.

00:53:45.000 --> 00:53:49.999
But I think it\'s a really important one for families
to have or we could develop the prototype of that

00:53:50.000 --> 00:53:54.999
and… and the software to put
that together uh… any place.

00:53:55.000 --> 00:54:00.080
And I think a group that could be very effective in doing this
would – would be the local (inaudible), the Alzheimer\'s society.

00:54:05.000 --> 00:54:09.999
When you start talking about alternatives,
then I think our society has long ways to go.

00:54:10.000 --> 00:54:14.999
Most of the alternatives we have are
not really appropriative for people

00:54:15.000 --> 00:54:19.999
who have a cognitive impairment and uh…
often some mobility problems as well.

00:54:20.000 --> 00:54:24.999
So, the buses jerk and birch and are just
really not very effective alternatives

00:54:25.000 --> 00:54:29.999
for people in our climate

00:54:30.000 --> 00:54:34.999
here just to wait out for a bus for 15 to 20
minutes, it\'s not a very effective way to go.

00:54:35.000 --> 00:54:39.999
But even in southern climates where
it\'s very hot, it\'s uh… equally bad.

00:54:40.000 --> 00:54:44.999
Taxi cabs, I think are not

00:54:45.000 --> 00:54:49.999
well thought of in the sense that
uh… people are pretty frugal,

00:54:50.000 --> 00:54:54.999
often in – it costs money and trying
to educate in terms of vouchers,

00:54:55.000 --> 00:54:59.999
it\'s pretty expensive to own a private
automobile too in terms of insurance

00:55:00.000 --> 00:55:04.999
and up-keep and so on. And there are a lot
of taxi cabs rides that could be taken.

00:55:05.000 --> 00:55:09.999
The next issue is so – what
does a taxi cab ride mean?

00:55:10.000 --> 00:55:14.999
Does it mean a stranger is always picking you up,
does it mean that they expect you to be in the car?

00:55:15.000 --> 00:55:19.999
And if you\'re not there, they\'re angry with you if you
don\'t get there quickly and they expect you to get out

00:55:20.000 --> 00:55:24.999
so they can get the next fare or can we have
some taxi cabs companies that really buy in

00:55:25.000 --> 00:55:30.000
and say we\'ll have door to door, maybe
even through the doors service.

00:55:35.000 --> 00:55:39.999
I went to get my driver\'s license a
few years ago. Uh… here I am 72.

00:55:40.000 --> 00:55:44.999
So, I – I ask the driver, the guy
who was giving the test, I said,

00:55:45.000 --> 00:55:49.999
how much problem do you have with the older
folks who come in and can\'t drive very well.

00:55:50.000 --> 00:55:54.999
And he gave – I still consider
with the class and he says well,

00:55:55.000 --> 00:55:59.999
we don\'t like to give you old folks a break
because they\'re not feeling confidence

00:56:00.000 --> 00:56:04.999
that\'s sending the person

00:56:05.000 --> 00:56:09.999
for a mandated driving test
was going to fix the problem.

00:56:10.000 --> 00:56:14.999
My solution for what it\'s worth

00:56:15.000 --> 00:56:19.999
would be that I think we should not just test the elderly,
but we should pretty much test everyone as they –

00:56:20.000 --> 00:56:24.999
even when they\'re 16 or 18 with
some simple kind of memory test

00:56:25.000 --> 00:56:29.999
that they then perform every five years or so and
probably would increase the frequency as they get older.

00:56:30.000 --> 00:56:34.999
So, in addition to getting your eyes checked
when you get your licenses renewed,

00:56:35.000 --> 00:56:39.999
you did a simple little memory test that would perhaps
take a couple of minutes. And if you fail that,

00:56:40.000 --> 00:56:44.999
it wouldn\'t mean that you couldn\'t drive or it just means that you would
then have to get checked out as to why you failed this little memory test.

00:56:45.000 --> 00:56:49.999
And there are tests that have been validated, they\'re
good for that. And I like the idea of testing everyone,

00:56:50.000 --> 00:56:54.999
not just the elderly because then
it\'s not discriminatory in any way.

00:56:55.000 --> 00:56:59.999
I do think that it\'s more than reasonable to test the
elderly more frequently. So, while we may test people

00:57:00.000 --> 00:57:04.999
between the age of 20 and 70 every
five or 10 years, you know,

00:57:05.000 --> 00:57:09.999
after a certain age, we should start testing more
frequently because we know the incidents of the dementia

00:57:10.000 --> 00:57:14.999
increases quite dramatically with
the age, over the age of, say 65.

00:57:15.000 --> 00:57:19.999
And the tests themselves are pretty easy doing administer so that
even the people at the department of motor vehicles who don\'t –

00:57:20.000 --> 00:57:24.999
maybe aren\'t specifically trained in neuropsychology, you
could be trained on how to administer one or two tests.

00:57:25.000 --> 00:57:29.999
And a simple test is the Trails B. That\'s the one I think
that would be useful as a widespread screening test.

00:57:30.000 --> 00:57:34.999
It only takes a couple of minutes and it could
be performed at the Department of Motor Vehicles

00:57:35.000 --> 00:57:39.999
when you go for a license renewal.
The test itself is a simple connect

00:57:40.000 --> 00:57:44.999
the dots test which is a time test. But it
requires a certain amount of mental flexibility

00:57:45.000 --> 00:57:49.999
that\'s been most shown to correlate well with the
ability to drive. And people who do poorly in a test

00:57:50.000 --> 00:57:54.999
have higher rates of crashes. So, I think
it would be a very useful screening test.

00:57:55.000 --> 00:57:59.999
I think that unfortunately it may take some … some
events, some tragedy like what happen in California

00:58:00.000 --> 00:58:04.999
to sort of umm… to get the forces rolling.
However, I think we have done a lot of leg work,

00:58:05.000 --> 00:58:09.999
the ground work so that if that
happens, we know what to do

00:58:10.000 --> 00:58:14.999
I think to start testing people. I just think it\'s going to
take it some initiative on the part of the public to say,

00:58:15.000 --> 00:58:19.999
you know, I know it would be inconvenient
if my mom or dad couldn\'t drive.

00:58:20.000 --> 00:58:25.000
But it\'s a heck of a lot worse if they
actually show up in an emergency room.