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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 . . . [Full Text of this Article]

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