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May 14, 2003

Cholinesterase Inhibitors for Alzheimer DiseaseCholinesterase Inhibitors for Alzheimer Disease

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(18):2359. doi:10.1001/jama.289.18.2359-a

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.

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