By Ileana Wachtel
Some states require that physicians report a diagnosis of dementia, including Alzheimer’s disease, to the DMV. A new study suggests these mandates may have unintended consequences.
Published April 25 in the Journal of the American Medical Association ’s JAMA Network Open , the study was led by researchers at the USC Dornsife College of Letters, Arts and Sciences in collaboration with a Harvard University researcher.
Why it matters: The increasing number of elderly drivers presents significant safety concerns for policymakers, physicians and society, considering they’re at greater risk of dementia. But no studies have examined the effects of state policies that require clinicians to report dementia cases to the DMV — until now.
At issue: For the new study, the researchers sought to determine whether physicians who are mandated by the DMV to report a diagnosis of dementia will be less likely to establish such a diagnosis. The short answer seems to be “yes.”
Key finding : Physicians in states with mandatory reporting laws are 50% more likely to under diagnose dementia, compared to physicians in states without such mandates.
The Big Picture: In the United States, the number of drivers aged 65 and older has increased by 22% since 2012, totaling nearly 56 million in 2021.
Important: If patients withhold symptoms out of fear their doctor will report a dementia diagnosis to the DMV,or physicians are reluctant to examine dementia symptoms for fear their patient could lose their driving license, that would worsen health outcomes and increase health care costs.
What else? Knowing that their physicians must report a dementia diagnosis to the DMV, patients might be more inclined to refuse further assessments.
In her words: “Patients already resist revealing symptoms of cognitive decline. Facing the threat of losing their driving privileges could make them less likely to seek essential cognitive evaluation, leading to more overlooked or postponed diagnoses,” said Ying Liu , a research scientist at CESR and co-author of the study.
In dispute: There is scant evidence that mandatory reporting laws reduce accident risks. States enact mandatory reporting laws believing they can enhance driving safety.
The lack of evidence hinders researchers’ ability to determine whether the benefits of reporting mandates outweigh the risks associated with the increase in missed diagnoses.
Zoom in: The diverse range of state policies regarding the mandatory reporting of dementia reflects the complexity and varying interpretations of the evidence.
Study methods : The researchers, analyzing Medicare data used for a previous study on mild cognitive impairment diagnoses, classified states based on their reporting laws.
What’s next? Mattke and his team say future study is needed to better understand the unintended consequences and risk-benefit tradeoffs of these policies.
JAMA Network Open
10.1001/jamanetworkopen.2024.8889
Observational study
People
State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis
25-Apr-2024