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August 14, 2002

Nursing Home Placement and Dementia—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(6):696-697. doi:10.1001/jama.288.6.693

In Reply: We agree with Dr Desai that access to care and early recognition are important considerations for patients with dementia. We also agree that many patients with dementia (and their families) would benefit from earlier diagnosis and treatment, which may be particularly true for patients with limited access to care, such as those living in rural areas and those with limited resources. Although cholinesterase inhibitors have a modest effect on cognitive symptoms in some patients with Alzheimer disease, there is little evidence to support the contention that early pharmacological treatment would delay nursing home placement or slow the rate of functional decline. Furthermore, the evidence on treatment of behavioral symptoms with cholinesterase inhibitors is inconclusive. More research is needed in these important areas. However, regardless of the impact of pharmacological therapy, early recognition of dementia is important to provide adequate support and counseling to patients and families.

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