Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: I have several concerns about
the patient selection in the study by Dr Mitchell and colleagues1 and
the implications for who should be considered for a palliative care program.
First, the patients in the study had Cognitive Performance Scores of
5 or 6, equivalent to a Mini-Mental State Examination score of 5 or lower.
Although these patients can be considered to have severe dementia, I do not
agree that a patient with a Mini-Mental State Examination score of 5 necessarily
has “advanced” dementia, assuming advanced to imply the terminal
stages of a disease.
Álvarez-Fernández B. Estimating Prognosis for Nursing Home Residents With Advanced Dementia. JAMA. 2004;292(13):1553-1554. doi:10.1001/jama.292.13.1553-a