Developing Physician Consensus on the Reporting of Patients with Mild Cognitive Impairment and Mild Dementia to Transportation Authorities in a Region with Mandatory Reporting Legislation Mark J. Rapoport, M.D., Gary Naglie, M.D., Nathan Herrmann, M.D., Carla Zucchero Sarracini, B.A., Benoit H. Mulsant, M.D., Christopher Frank, M.D., Alex Kiss, Ph.D., Dallas Seitz, M.D., Brenda Vrkljan, Ph.D., Mario Masellis, M.D., Ph.D., David Tang-Wai, M.D., Nicholas Pimlott, M.D., Frank Molnar, M.D. Objective: To establish consensus among dementia experts about which patients with mild cognitive impairment (MCI) or mild dementia should be reported to trans- portation authorities. Methods: We conducted a literature review of predictors of driving safety in patients with dementia and combined these into 26 case scenarios. Using a modified Delphi technique, case scenarios were reviewed by 38 dementia experts (geriatric psychiatrists, geriatricians, cognitive neurologists and family phy- sicians with expertise in elder care) who indicated whether or not they would report the patient in each scenario to regional transportation authorities and recommend a specialized on-road driving test. Scenarios were presented up to five times to achieve consensus, defined as 85% agreement, and discrepancies were discussed anony- mously online. Results: By the end of the fifth iteration, there was cumulative consensus on 18 scenarios (69%). The strongest predictors of decision to report were the combination of caregiver concern about the patient’s driving and abnormal Clock Drawing Test, which accounted for 62% of the variance in decision to report at the same time as or without a road test (p <0.01). Based on these data, an algorithm Received April 17, 2013; revised November 27, 2013; accepted December 2, 2013. From the Department of Psychiatry (MJR, NH, CZS) and Department of Neurology (MM), Sunnybrook Health Sciences Centre, Centre for Addiction and Mental Health (BHM), Institute of Health Policy Management & Evaluation (AK, GN), Department of Neurology (DT-W), University Health Network, and Department of Family and Community Medicine (NP), Women’s College Hospital, Department of Medicine and Rotman Research Scientist (GN), Baycrest Geriatric Health Care Centre; Research Department (GN), Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Geriatric Medicine (CF) and Division of Geriatric Psychiatry (DS), Providence Care, Queen’s University, Kingston, Ontario, Canada; School of Rehabilitation Science (BV), McMaster University, Hamilton, Ontario, Canada; and Division of Geriatric Medicine (FM), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. Presented in part at the annual meeting of the Canadian Academy of Geriatric Psychiatry, Banff, Alberta, Canada, September 21e22, 2012, and at the annual meeting of the American Association for Geriatric Psychiatry, Los Angeles, CA, March 14e17, 2013. Send correspondence and reprint requests to Mark J. Rapoport, M.D., Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario, Canada M4N 3M5. e-mail: Mark.Rapoport@sunnybrook.ca Supplemental digital content is available for this article in the HTML and PDF versions of this article on the journal’s Web site (www. ajgponline.org). Ó 2013 American Association for Geriatric Psychiatry http://dx.doi.org/10.1016/j.jagp.2013.12.002 Am J Geriatr Psychiatry -:-, - 2013 1