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October 6, 2004

Estimating Prognosis for Nursing Home Residents With Advanced Dementia

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(13):1553-1554. doi:10.1001/jama.292.13.1553-a

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.