Incipient Alzheimer's Disease as the Underlying Cause of a Motor Vehicle Crash

Abstract

A 75-year-old female driver died in a single vehicle crash. A forensic autopsy diagnosed the cause of death as blood loss due to laceration of the liver caused by the crash. Although she had neither clinical history of dementia nor gross abnormalities of the brain, neuropathological examinations showed a substantial number of senile plaques indicative of Alzheimer's disease (AD). An interview with a family member revealed that she had symptoms of dementia. Cognitive dysfunction due to AD was proposed as the underlying cause of the crash. It is recommended that forensic autopsy of older drivers should include neuropathological examinations to identify incipient AD. Recognition of AD as an underlying cause of crashes is also important to promote the health care of older people.

Get full access to this article

View all access options for this article.

References

DeArmond

S. J.

Dickson

D. W.

DeArmond

(1997) Degenerative diseases of the central nervous system. In: Davis

R.L.

Robertson

D.M.

(Eds), Textbook of Neuropathology, 3rd ed. Baltimore, Williams and Wilkins, pp. 1063–178

Dickson

D. W.

(1997) The pathogenesis of senile plaques. J. Neuropathol. Exp. Neurol. 56, 321–39

Friedland

R. P.

Koss

Kumar

Gaine

Metzler

Haxby

J. V.

Moore

(1988) Motor vehicle crashes in dementia of the Alzheimer type. Ann. Neurol. 24, 782–6

Johansson

Bronge

Lundberg

Persson

Seideman

Viitanen

(1996) Can a physician recognize an older driver with increased crash risk potential? J. Am. Geriatr. Soc. 44, 1198–204

Kawas

Gray

Brookmeyer

Fozard

Zonderman

(2000) Age-specific incidence rates of Alzheimer's disease. The Baltimore longitudinal study of ageing. Neurology 54, 2072–7

Khachaturian

Z. S.

(1985) Diagnosis of Alzheimer's disease. Arch. Neurol. 42, 1097–105

Kibayashi

Honjyo

Higuchi

Tsunenari

(1998) Binswanger's disease. A rare cause of dementia in elderly persons. Jpn. J. Leg. Med. 52, 46–50

Kibayashi

Ng'walali

P. M.

Hamada

Honjyo

Tsunenari

(2000) Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of ‘talk and die’ head injury. Legal Med. 2, 175–80

McGwin

Sims

R. V.

Pulley

Roseman

J. M.

(2000) Relations among chronic medical conditions, medications, and automobile crashes in the elderly: A population-based case-control study. Am. J. Epidemiol. 152, 424–31

10.

Ministry of Public Management, Home Affairs, Posts and Telecommunications. (2000) White paper on traffic safety. Tokyo, Printing Bureau of Finance Ministry

11.

Mirra

S. S.

Heyman

McKeel

Sumi

S. M.

Crain

B. J.

Brownlee

L. M.

Vogel

F. S.

Hughes

J. P.

van Belle

Berg

(1991) The consortium to establish a registry for Alzheimer's disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology 41, 479–86

12.

O'Neill

(1992) Physicians, elderly drivers, and dementia. Lancet 339, 41–3

13.

Ott

Breteler

M.M.B.

van Harskamp

Claus

J. J.

van der Cammen

T.J.M.

Grobbee

D. E.

Hofman

(1995) Prevalence of Alzheimer's disease and vascular dementia: Association with education. The Rotterdam study. Brit. Med. J. 310, 970–3

14.

Spitz

W. U.

(1993) Spitz and Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, 3rd ed. Springfield, Charles C. Thomas, pp. 528–66

15.

Viitanen

Johansson

Bogdanovic

Berkowicz

Druid

Eriksson

Krantz

Laaksonen

Sandler

Saukko

Thiblin

Winblad

Kalimo

(1998) Alzheimer changes are common in aged drivers killed in single car crashes and at intersections. Forensic Sci. Int. 96, 115–27

16.

Vonsattel

J.P.G.

Myers

R. H.

Hedley-Whyte

E. T.

Ropper

A. H.

Bird

E. D.

Richardson

E. P.

(1991) Cerebral amyloid angiopathy without and with cerebral hemorrhages: A comparative histological study. Ann. Neurol. 30, 637–49

17.

Walsh

J. S.

Welch

H. G.

Larson

E. B.

(1990) Survival of outpatients with Alzheimer-type dementia. Ann. Intern. Med. 113, 429–34