EDITORIALS

Gastrostomies in dementia: bad practice or bad evidence? Tube feeding in dementia remains controversial as evi-denced by recent responses to the Royal College of Physicians (RCP) report on oral feeding [1]. Criticisms of non-oral feeding are based on a failure to show a favourable outcome [2] or to lengthen survival [3, 4], a worsening of prognosis [5] and a higher mortality rate in hospitalised pa-tients [6]. When dysphagia become severe, nasogastric tubes are often the first recommendation [1], with gastrostomies inserted once the patient is well enough to tolerate the pro-cedure. However, there are many unanswered questions about tube feeding in general and gastrostomies in particular with respect to dementia: (i) What causes weight loss in dementia? The cytokine