Rozzini et al provide important outcome data, which adds to the debate on appropriate treatment of intercurrent disease in patients with severe dementia. Their data are consistent with data from the United States; Morrison and Siu1 also found that despite hospitalization and aggressive treatment, pneumonia is often, but not always, fatal in patients with end-stage dementia (6-month mortality: 53%, compared with 13% for cognitively intact patients). Our Italian colleagues raise 2 issues we would like to address. First, could Dutch physicians have saved additional patients with antibiotic treatment? This issue is raised by the 3 (20%) of 15 survivors with "end-stage dementia" found by Rozzini et al. There could be debate about the definition of end-stage dementia; however, the bigger issue is how much difference antibiotic treatment makes. In a 1990 report, Fabiszewski and colleagues2 found that nursing home residents with the most severe dementia had a similar probability of long-term survival from a febrile illness whether treated with antibiotics or palliatively. However, in our larger study on pneumonia, we found much higher mortality among residents with dementia in whom antibiotic treatment was withheld.3 Likely, this was both due to nontreatment and to higher frailty compared with treated patients (Figure 1). Therefore, antibiotics are likely effective in curing pneumonia in some patients with end-stage dementia.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Long-term survival of pneumonia patients with dementia by treatment. Blue line, AB-curative: the patients treated with antibiotics for curative reasons (n = 470); red line, AB-palliative: the patients treated with antibiotics for palliative reasons (n = 50); and black line, AB-withheld: the patients in whom antibiotic treatment was withheld (n = 165). The latter had more severe dementia and were frailer than AB-curative patients; AB-palliative patients were in between but closest to AB-withheld patients. Type of antibiotic treatment for AB-curative and AB-palliative patients was similar, as reported in our article.3
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
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 4
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
Users' Guides to the Medical Literature
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.