Author's reply

Dr Jha feels that our study is flawed by an inclusion of only 65% of patients willing to participate. A participation rate of 65% is common in this type of study. We anticipated before the start of the study that the rate of non-participants might amount to 40%, and therefore the actual inclusion rate was higher than expected. More importantly, the two groups did not differ regarding relevant characteristics affecting the prognosis, such as age, diagnosis, gender and baseline cognition. Moreover, Dr Jha found the results of our study quite modest. We do not entirely agree with this: a difference of 9.6% between groups regarding health-related quality of life is higher than found in any pharmacological study in dementia so far. We furthermore emphasise that usual care in our region is provided by an active university medical centre and a community mental health service that have collaborated in the past on several projects. We therefore expect that the effects of our study may be underestimated, and would be higher in other regions. Indeed, a marriage between different disciplines involved in the care of people with dementia sometimes involves conflict and is dependent on the willingness to invest in the relationship. So far, a lot of work has already been performed and although the marriage still isn't perfect, we think that it does have a realistic and happy future.