BMJ 1999;319:640 ( 4 September )

Letters

Effectiveness of rivastigmine in Alzheimer's disease

    Improvements in functional ability remain unestablished
    Authors' reply
    Patients' view on quality of life should be assessed
    Guidelines do not ignore clinically relevant end points

Improvements in functional ability remain unestablished

The first 150 words of the full text of this article appear below.

EDITOR---Two recent reports on rivastigmine in Alzheimer's disease 1 2 provide further proof that cholinesterase inhibitors produce modest improvements in cognitive testing and in clinical impression of change. The new claim is of improved functionality with rivastigmine, which, if true, would be an important advance in the management of Alzheimer's disease.

Unfortunately, however, these studies do not establish that functional ability is improved. Both studies rated functionality using the progressive deterioration scale, which was developed to assess quality of life not activities of daily living.3 It contains considerable duplication (for example, four questions on handling finances), and only two items relate peripherally to the basic activities of dressing and eating. It cannot be concluded, therefore, that improved scores equate to improved functionality.

Moreover, Rösler et al misrepresent the small improvement in progressive deterioration score seen with rivastigmine (2.8 on a 100 point scale) by citing in the discussion that one third of . . . [Full text of this article]
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