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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We have read with interest the article by Ernst et al¹ on the association between cognitive decline and the costs of Alzheimer disease (AD). The authors found no significant association between patients' Mini-Mental State Examination (MMSE) score and indirect cost, as defined by hours spent by caregivers for patients' assistance.

With the aim to obtain detailed estimates of the direct and indirect costs of AD in Italy, we performed a longitudinal study from 1994 to 1996.² A sample of 103 patients with AD (77% women; mean[±SD] age, 77.7±7.3 years; mean[±SD] MMSE score, 10.2±7.5; 34% had a Clinical Dementia Rating [CDR] scale score of 1, 25% had a CDR score of 2, and 41% had a CDR score of 3) living at home were included. Clinical assessment, including MMSE score and functional status measured through the number of basic activity of daily living³ (ADL) and instrumental⁴ ADL (IADL) abilities lost, was . . . [Full Text of this Article]