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We appreciate Dr Fotuhi's interest in our article.1 He raises important issues about a long-standing problem in the field, the accuracy of dementia diagnosis in the oldest old persons. Performance of daily activities often is compromised in very old individuals, and it can be difficult to determine whether the functional losses are owing to cognitive vs physical impairments (or both). Even when the losses are caused by cognitive changes, many possible disorders may be responsible. In this context, Dr Fotuhi suggests that the individual described in our recent article in the Archives of Neurology represents a case of overdiagnosing DAT. For the reasons enumerated below, we respectfully disagree with this suggestion and with several of his comments.
Cairns NJ, Morris JC. The Challenge and Public Health Implications of Alzheimer Overdiagnosis in the Oldest Old—Reply. Arch Neurol. 2010;67(7):899-901. doi:10.1001/archneurol.2010.139