Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
To the Editor: The meta-analysis of Dr Trinh
and colleagues1 may have underestimated
the functional benefit of ChIs, as it did not include studies that used the
Disability Assessment for Dementia (DAD) scale and Alzheimer's Disease Cooperative
Study/Activities of Daily Living (ADCS/ADL) inventory. Both are validated
measures of functional ability designed to assess the progressive decline
in ADLs seen in AD.1,2 Excluding
such scales appears arbitrary and significantly limits the value of this meta-analysis,
as others have suggested that scales that include basic and instrumental ADLs
should be used to evaluate disability in AD.1,2 Both
the DAD and ADCS/ADL scales can be divided into basic and instrumental items
to provide greater understanding of the decline in functional abilities in
dementia patients. Furthermore, reporting treatment effects without regard
to dose is a potential limitation.
Lilienfeld S. Cholinesterase Inhibitors for Alzheimer DiseaseCholinesterase Inhibitors for Alzheimer Disease. JAMA. 2003;289(18):2359. doi:10.1001/jama.289.18.2359-a