Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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
Mitchell SL. Estimating Prognosis for Nursing Home Residents With Advanced Dementia—Reply. JAMA. 2004;292(13):1553-1554. doi:10.1001/jama.292.13.1553-b