To the Editor.
—In their article, Dr Ross and colleagues1 showed that dementia frequently remains unrecognized by relatives of home-dwelling subjects with dementia. Among factors associated with unrecognized dementia, a few behavioral complications and functional disabilities are worthy of some comment. Indeed, we found that patients whose dementia was recognized on the occasion of an unrelated hospital stay continued to do some activity after retirement, were considered by their relatives to run a negligible risk in performing such activities, and could receive adequate informal support.2 As hypothesized by Ross and colleagues,1 poor awareness of the presentation of dementia and respect for the elderly contributed to prevent dementia recognition. Additionally, relatives of patients unrecognized to be demented thought that drugs and institutionalization could not help manage dementia.2 Interestingly, these conditions clustered in rural areas: rural residence and low occupational role before retirement were independent correlates of unrecognized dementia. In this
Incalzi RA, Gemma A, Carbonin P. Underrecognition of Dementia by Caregivers Cuts Across Cultures. JAMA. 1997;277(22):1757-1758. doi:10.1001/jama.1997.03540460023015