We thank Dr Walsh for his comments and note that he has long been interested in the care of demented patients and their families. We would disagree, however, with his recommendations regarding the use of anticoagulants in demented patients. His study1 showed that two thirds of a group of patients whose conditions were diagnosed as demented improved after two years of treatment with warfarin sodium. However, there was no control group, and judgments about treatment response were not blind. Since the term dementia refers to a number of illnesses, many of which have variable courses, a controlled study is necessary. Furthermore, the most common dementing illness, Alzheimer's disease, is not associated with vascular abnormalities.2 Thus, a therapeutic effect in patients with Alzheimer's disease seems unlikely.We also believe that there are possible risks involved in anticoagulating patients with dementia because they are prone to fall. The
Rabins PV, Mace NL, Lucas MJ. Improvement of Dementia-Reply. JAMA. 1983;249(3):353–354. doi:10.1001/jama.1983.03330270023021
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