## 2 Background  
The growing population of those over 65 years old in the U.S. has led to a corresponding surge in the prevalence of age-related conditions like dementia. According to the Centers for Disease Control (CDC), one in nine people within the U.S. aged 65 and older have a diagnosis of dementia [3]. Dementia is an overarching term that encompasses many different subtypes, including Alzheimer's disease (AD), which can present with a cluster of symptoms such as loss of memory, language, problem-solving, and other executive function deficits [4]. The presence of these symptoms may interfere with the individual's daily routines and lead to the loss of certain skills and abilities as the disease progresses [4]. Driving is one area that can be largely impacted when symptoms of cognitive decline associated with the onset of dementia begin to emerge. Changes in memory, attention, processing speed, visual and spatial abilities, judgment, and reasoning may pose challenges in critical aspects of driving [5; 6]. These cognitive changes when combined with driving raise concerns, as driving is a multi-level task that places a high demand on many cognitive, perceptual, and motor functions [7]. The driving environment is dynamic and unpredictable, and therefore the ability to execute real-time decisions is a large factor in sustained safe driving. The task demands the need for attention, quick reaction times, and a high level of cognition to adjust and adapt effectively to make decisions to meet the needs of the changing environment. When these critical skills are impacted by cognitive impairment, the likelihood of unsafe actions and poor decision-making increases, raising concerns about the safety of the driver and those around them. The amount of risk associated with driving and dementia has been connected to the stage or severity of the disease [8]. An individual in the mild stages may not yet be showing any signs of concern when driving. However, studies have observed the frequency of vehicle crashes increases on or after year three of dementia onset [8]. After three years of onset, individuals with dementia are known to experience a more significant decline in cognitive domains such as attentional capacity, processing speed, executive functions, and visuospatial skills [6]. Previous studies that have analyzed the frequency and odds of road accidents among drivers with dementia offer interesting perspectives. One of the preliminary studies found that drivers with dementia had an overall mean annual crash rate of 0.091, compared with 0.040 for age-matched controls [9]. This represented a slightly increased risk in crash rates for this population, with incremental increases with years from onset of disease. In the early stages of dementia, there were notably lower crash rates; in year one, the crash rate was 0.068, in year three, 0.093, and in year five, 0.129 [7]. Furthermore, when aging and time since onset of dementia were factored in, drivers between the ages of 70 and 79 were 2.9 times more likely, and drivers aged 80 years and older were 7.5 times more likely, to misjudge or fail to detect a vehicle approaching the intersection, resulting in a crash [10]. In contrast, a retrospective cohort study examining crash risk for licensed individuals aged 65-79 years showed that individuals with dementia had lower rates of car crashes compared to those without dementia [11]. A plausible reason for this finding was that individuals with dementia reported lower driving mileage as a result of changes in their driving habits, often enforced by family members and caregivers. Such limited driving exposure may not accurately reflect the risky driving behaviors present in this population, potentially underemphasizing the importance and need for an intervention and evaluation of the associated risks. Safety should be a main priority when determining whether an individual should continue to drive or have their license revoked.