In Reply We thank Volicer and Hurley for their letter and applaud them for bringing issues concerning discomfort in dementia into public debate.
Our approach of examining sources of discomfort differs completely from that of Volicer and Hurley. Their approach involves examining discomfort signs such as facial grimaces. While their approach has indeed been used to detect discomfort, many of these signs and symptoms are also used to detect pain,1 reflecting an unclear distinction between the constructs. Examining these behaviors for detecting pain and discomfort is indeed essential to dementia care. Yet, examining the sources of discomfort alone is equally important because it uncovers discomfort even in persons not manifesting the aforementioned signs and because it directs caregivers toward means for remedying discomfort.
Cohen-Mansfield J, Marx MS, Thein K. What Is Discomfort in Persons With Dementia Who Are Agitated?—Reply. JAMA Intern Med. 2014;174(2):292-293. doi:10.1001/jamainternmed.2013.11991