in Dementia Patients (Part 1) Screaming is a behavioural problem that can be extremely overwhelming and create enormous stress, not only on other patients, but on staff as well. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Yi-Ting Kuo, Junne-Ming Sung, Chien-Yao Sun, Jia-Ling Wu & Yu-Tzu Chang, Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan, Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Junne-Ming Sung, Jung-Der Wang & Yu-Tzu Chang, Department of Neurology, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan, You can also search for this author in JAMA. For the families of my patients with dementia, stopping donepezil or memantine is most difficult, for this is often closely tied to their hope that the medication will cease or significantly slow the progressive course of the disease. A study was performed in Japan to elicit the preferences of patients on haemodialysis with regard to the continuation of the dialysis if they were severely demented or had terminal cancer [21]. https://doi.org/10.1186/s13195-019-0486-z, DOI: https://doi.org/10.1186/s13195-019-0486-z. Nevertheless, ESRD was associated with decreased absolute risk of dementia over time because its sdHRs were less than 1 (Table 3). The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. et al. Stratified analysis of risk for dementia between the end-stage renal disease (ESRD) and non-ESRD population by using multivariable subdistribution hazard models*. Furthermore, the subtype of dementia (Alzheimer’s disease [ICD-9: 331.0], vascular dementia [ICD-9: 290.4], or unspecified dementia [ICD-9: 290.0-290.3, 294.1, 331.1 and 331.2]) or the medical specialists of primary physicians responsible for the diagnosis of dementia were also recorded to facilitate further analyses in this study. Furthermore, the opposite direction of csHRs (> 1) and sdHRs (< 1) for the association between ESRD and risk of dementia noted in our study could happen if both the effect of cause-specific hazard ratios associated with all-cause mortality is strong enough and the baseline cause-specific hazard rate for all-cause mortality is of great magnitude [32], as shown in Table 3 and Additional file 1: Table S4. Choi AI, Weekley CC, Chen SC, Li S, Tamura MK, Norris KC, Shlipak MG. Association of educational attainment with chronic disease and mortality: the Kidney Early Evaluation Program (KEEP). 2005;104(3):157–63. Conflict of interest statement. Miura Y, Asai A, Nagata S et al. Alzheimer's Research & Therapy Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. There may come a time when you feel you want to discontinue dialysis treatment. Only one practitioner had never refused starting an elderly patient on haemodialysis. For Permissions, please email: journals.permissions@oxfordjournals.org. Given the increased life expectancy and aging of the population worldwide, the burden of dementia in the ESRD population is expected to increase, especially in Asia where the incidence rate of dementia is higher than other geographic areas [16]. ESRD was still associated with inverse relationships between cause-specific hazards and subdistribution hazards for either overall or any subtype of dementia (Additional file 1: Table S4). [6] clearly demonstrated that severe neurological sequelae of stroke constitute sufficient justification for nephrologists in the US to refuse or discontinue dialysis. JAMA Intern Med. Overall and age- and sex-specific incidence rates (IRs) of dementia between end-stage renal disease (ESRD) and non-ESRD population in the sensitivity analyses, for which dementia is diagnosed by neurologists and psychiatrists. The most straightforward study design is to compare the difference in risk of dementia between matched pairs generated from the ESRD and non-ESRD populations by various matching statistical techniques. To validate the accuracy of the diagnosis of dementia, we confined the primary physicians responsible for the diagnosis of dementia to only neurologists and psychiatrists and re-analyzed all the results by following the same study criteria (Additional file 1: Table S1, Additional file 1: Tables S3 and S4 and Additional file 1: Figures S1 and S3). 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