Objective: To evaluate the impact of continued Reality Orientation Therapy (ROT) in delaying the outcomes of dementia progression. Design: Retrospective study. Data collection was based on review of clinical charts and on telephone interviews performed with patients or primary caregivers. Setting: Day hospital of the Alzheimer's Disease Unit, Brescia (Italy). Subjects: Seventy-four patients enrolled in at least one cycle of ROT from 1994 to 1998 were studied. Interventions: Rehabilitative intervention based on formal ROT. Main outcome measures: This study analysed the time to the occurrence of any of the following: cognitive decline on Mini-Mental State Examination scores, urinary incontinence as an index of functional decline, institutionalization, and death. Results: Data on a 30-month period after the first ROT session were analysed. We compared 46 patients (treatment group) who completed from 2 to 10 ROT cycles (corresponding to 8-40 weeks of training; mean = 15.48) with 28 patients (control group) who completed only one ROT cycle (4 weeks). Treatment group showed higher estimated survival rates than control group on cognitive decline (p = 0.022) and institutionalization (p = 0.002). The relative risks for cognitive decline and institutionalization in the control group compared with treatment group were 0.60 (p = 0.014), and 0.42 (p = 0.021), respectively. Conclusions: Continued ROT classes during the early to middle stages of dementia may delay nursing home placement and slow down the progression of cognitive decline.