We thank Roy R. Reeves, DO, PhD, and Mark E. Ladner, MD, for their comments regarding our July article (J Am Osteopath Assoc. 2006;106:412-414). Our preliminary findings highlight significant associations between neuropsychiatric symptoms and the degree of medical illness in outpatients diagnosed as having dementia. We believe that primary care physicians play an important role in screening for mental status and behavioral change when patients report only physical symptoms. Conversely, physicians also need to be aware that neuropsychiatric symptoms or an altered mental status may be the only symptoms indicative of an underlying medical illness (eg, urinary tract infection). We absolutely agree with Drs Reeves and Ladner that there is a danger in attributing changes in mental status solely to a neuropsychiatric origin, especially in patients with dementia.