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In Reply: We agree with Dr Álvarez-Fernández that "advanced" dementia does not necessarily mean "terminal" dementia. The objective of our study was to create a risk score to estimate survival among nursing home residents with advanced dementia in order to identify the "terminal" individuals among those with advanced disease. Progressive cognitive dysfunction is the hallmark of dementia. Therefore, in order to select a cohort with advanced disease, we identified residents with dementia who had severe cognitive dysfunction. A Cognitive Performance Score of 5 or 6 has been shown to correlate with severe cognitive impairment in individuals with dementia.^1-2

All independent variables in our study, including functional status, were determined from the Minimum Data Set (MDS) assessment completed within 21 days of nursing home admission. We agree that some individuals may have been clinically stable during this period, while others may have been unstable. We included all acute illnesses available in . . . [Full Text of this Article]

Susan L. Mitchell, MD, MPH
smitchell@mail.hrca.harvard.edu
Department of Medicine
Hebrew Rehabilitation Center for Aged
Boston, Mass

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Estimating Prognosis for Nursing Home Residents With Advanced Dementia
Baldomero Álvarez-Fernández
JAMA. 2004;292(13):1553.
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