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.
Second, the study included patients with infections, severe organ failure, and even associated cancer. However, it is not clear whether the functional evaluation was undertaken during a period of clinical stability or instability. This might mistakenly lead to a prognostic factor from an associated disease being considered a prognostic factor for terminal dementia.
Third, distinction should be made between a factor being prognostic or being an evolutionary factor characterizing the terminal stage of a chronic progressive fatal disease such as dementia. For instance, in the study by Mitchell et al and in other studies of survival that have included patients in all stages of dementia,2 - 5 male sex appears as a factor associated with a poor prognosis; however, this does not mean that if the patient is a man he is in a more or less advanced stage. Thus, this information, while useful as a prognostic factor, is of no benefit when deciding whether a patient should be included in a palliative care program. Age is another similar factor.
While I recognize the value of this study as a prognostic analysis, I believe that when making these decisions it is more important to know what characteristics suggest that a patient is in the terminal stage of a disease rather than knowing the prognosis in particular clinical situations.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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