We would like to thank Professor Waldorff and research group for the article about psychosocial interventions in patients with mild Alzheimer´s disease in BMJ, 17th July 2012.
There is a high comorbidity of early dementia and depression (Aminzadeh F, Ageing Mental Health 2007; Ownby RL, Arch Gen Psychiatry 2006; Burns A, BMJ 2009) that worsens the outcome (Modrego PJ, Aging Clin Exp Res 2004, Starkstein SE, Int Rev Psychiatry 2008), so the significant positive effect of “DAISY” on depressive symptoms is relevant.
The intervention of Waldorff et al combines caregiver support, psychosocial and biographical aspects, validation and empowerment, i.e. most of the approaches shown to be effective in literature (Woods B, Cochrane Database 2005; Olazaran J, Dement Geriatr Cogn Disord 2010; Tilvis RS, Lancet 2000, Bennett DA, Lancet Neurol 2006, Werheid K, Int J Geriatr Psychiatry 2009, Kasl-Godley J, Clin Psychol rev 2000) even if previous data is limited and sometimes of poor quality.
With support by the Robert Bosch and the Dietmar Hopp foundations, our working group performed a trial about cognitive behavioural therapy (CBT) in physically ill patients with comorbid depression with a mean age of 82 (“AIDE- Acute Illness and depression in elderly patients”, Hummel et al. 2012; further publications in preparation). Although we could demonstrate that CBT was highly effective in this patient group, the intervention showed comparatively little effect and considerably less benefit in the subgroup of mildly cognitively impaired patients (Hummel J et al, Z Gerontol Geriatr 2012). Qualitative analyses of our data revealed the importance of stress factors like increasing loneliness and functional loss in old age and comorbidities like depression and dementia that can enhance the progress of disease and limit the efficacy of therapies.
Thus, both the study by Waldorff et al. applying a philosophical approach as part of a combined intervention and our own data with CBT stress the need to develop new types of psychosocial intervention in early dementia.

Competing interests: None declared