Getting Around With Early Alzheimer’s: How to Keep Your Independence and Also Stay Safe

For many people diagnosed with early-stage Alzheimer’s disease, daily life still feels relatively familiar. You may be managing your own schedule, running errands, meeting with friends, and even driving.

But because memory, attention, and decision-making abilities are gradually changing, activities that were once automatic may require a bit more planning and precaution.

In most cases, the goal at this stage of the disease isn’t to restrict your independence but to support it safely. Here’s what to keep in mind as you continue to move around your community with confidence.

Madisen Redar, an occupational therapist and leader of the neurorehabilitation program at Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, emphasizes that the process — to determine if and where it’s safe to drive — should start early.

“Your neurologist can evaluate changes in your neurological condition and function from one visit to the next,” says Redar.

She suggests requesting a referral to occupational therapy or a certified driver rehabilitation specialist to assess fitness to drive and skills that impact safe driving ability.

Even if skills are not affected early in the disease process, assessment for fitness to drive should be reviewed every six months to a year with progressive diseases or as subjective complaints from the client or from family arise, says Redar.

In addition to evaluating changes in physical, mental, or cognitive function that may affect driving, an occupational therapist can develop a transportation plan to allow you to stay active and independent in the community when you can no longer safely drive yourself.

Driving rules vary widely across the United States. Some states automatically restrict driving once a person is diagnosed with Alzheimer’s or another form of dementia. Others allow you to continue driving if you can pass a test. A few states require physicians to report dementia diagnoses directly to the state’s Department of Motor Vehicles (DMV).

Redar encourages people to ask their medical team direct questions, such as whether their provider is required to notify the DMV.

While there are some strategies that may help you drive safely for longer, continuing to drive and knowing what safety “guardrails” you should follow needs to be done in collaboration with your rehabilitation team and neurologist, says Redar.

“Everyone is different, and people must know that driving cessation will take place at some point in the disease process,” she says.

If there is anxiety about driving at night, in unfamiliar surroundings, at rush hour, or in bad weather, most people with early Alzheimer’s self-limit themselves.

If your evaluation clears you for driving, there are tools and strategies that can support safer driving:

• A GPS device or navigation app
• Sticking to familiar, well-practiced routes
• Driving only during daytime hours
• Avoiding freeways or complicated intersections
• Using blind-spot monitoring or other assistive vehicle features

Redar stresses that these should never replace a formal evaluation.

“Once errors become more frequent and skills begin to decline, these tools and strategies become insufficient,” she says. Driving should be closely monitored as the disease progresses.

Redar says that any of the following are signs of unsafe driving when you have Alzheimer’s disease:

• Getting lost driving to familiar locations
• Confusing the gas and the brake pedals
• Failing to notice and obey traffic signs
• Using others to assist with directions in the car
• New dents or scrapes on the car
• Hitting the curb when backing up
• Driving at inappropriate speeds
• Getting traffic tickets
• Having difficulty maintaining correct lane positions
• Having difficulty seeing at night
• Neglecting blind spots
• Getting too close or too far away from other vehicles
• Abnormal or involuntary movements while driving
• Other drivers honking their horns at you

There are also signs that you may need to stop driving that have nothing to do with driving itself. Those include:

• Increased agitation or confusion
• Needing assistance with basic activities of daily living, such as bathing and getting dressed
• Errors in essential activities, like paying bills, managing medications, managing home needs, and scheduling appointments

Transitioning away from driving can feel overwhelming, but having a plan can make the shift more manageable and help preserve your independence.

Occupational therapists play an important role here as well. They can help you evaluate your cognitive skills, identify safe transportation options, and craft a personalized plan based on your routine, says Redar.

Plans might include grocery delivery, rides from family or friends, local transportation services for older adults, taxis, or ride-sharing apps.

Staying Safe With Public Transit or Rideshares

Getting around via public transportation, taxis, and ride-sharing services (like Uber or Lyft) may be manageable by some people with early-stage Alzheimer’s, but there are multiple steps that could be a challenge for someone with impaired executive function, says Redar.

For public transportation, you need to be aware of schedules, planning a route, and where to get off and on if you need to change buses or trains.

Ride-sharing apps require sequencing multiple steps, from sharing your location, entering your destination correctly, booking the ride, to ending the task by tipping the driver in some cases, says Redar.

“As the disease progresses, individuals living with Alzheimer’s will need supervision from a care partner to ensure safe utilization of services,” Redar says. An occupational therapist can help determine whether these tasks are still safe.

Where to Find Local Transportation Help

Your state Department of Health and Human Services, local council on aging, and community volunteer driver programs can provide information about transportation resources. Many communities also offer reduced-cost taxi vouchers, senior shuttle services, or paratransit options for people with cognitive impairment.

Walking can be an excellent way to stay active, maintain strength, and even run simple errands if you live in a pedestrian-friendly area. But safety is essential, because orientation and judgment can fluctuate day to day.

Redar recommends being evaluated by a rehabilitation professional to make sure walking alone is still safe. Together, you can discuss questions such as:

• Can you maintain your balance during longer walks?
• Do chronic pain or fatigue limit your endurance?
• Are you able to safely cross streets and navigate intersections?
• Can you reliably follow a route without getting lost?
• Can you use your phone to call for help or navigate home if needed?

Precautions to Keep You Safe While Walking

If you’re able to get around on foot, the following tips can help keep you safe:

• Stick to familiar routes with sidewalks and good lighting.
• Avoid areas with heavy traffic.
• Let someone know where you’re going.
• Carry a fully charged cellphone.
• Wear comfortable, supportive shoes.
• Carry water, especially in warm weather.
• Walk with a buddy when possible.

Walking groups or community fitness programs can provide social interaction and extra safety.

Tools That Can Help You Stay Independent

Certain devices can serve as a safety net and allow you to stay active.

ID Bracelets
These include your name, medical condition, and emergency contact information, and some have GPS capability. They allow other people, including first responders (if there’s a medical issue), to quickly assist if you get lost.

Medical Alert Devices
Some devices can detect falls and allow quick access to a help center.

GPS Trackers
These can be worn in shoes, clipped to clothing, or carried in a pocket. “Some devices may have alerts for a caregiver when a person living with dementia moves beyond a certain geographical point,” Redar says.

These devices can be found at The Alzheimer’s Store or through an internet search for medical alerts or trackers.

Early-stage Alzheimer’s can be an ideal time to talk with your healthcare team and loved ones about mobility, safety, and independence. Support should come from an interdisciplinary team including neurologists, rehabilitation therapists, social workers, behavioral health specialists, and support groups, says Redar.

Rehabilitation specialists can also provide caregiver training, environmental modifications, communication strategies, and techniques to help you stay safe as the disease progresses.

• Staying active in early-stage Alzheimer’s can help maintain mobility and independence. Because driving abilities can change, regular evaluation by your neurologist and an occupational therapist can help you decide when to limit or stop driving.
• In general, risk correlates loosely with disease progression, slowly increasing as the disease advances. Limits on driving at night, in unfamiliar places, and in bad weather should be in place first; these are usually self-imposed because people affected no longer feel comfortable.
• If there is cause for concern and disagreement, then a formal third-party driving evaluation can help.
• A transportation plan that includes walking, rideshares, community programs, or help from family can make the shift away from driving smoother and keep you engaged in daily life.
• Safety tools, such as ID bracelets, medical alert devices, and GPS trackers, can support independence while giving you and your care partners peace of mind.