• Kenneth Rockwood, Michael Wallack, and Raymond Tallis.
• Dalhousie University, Halifax, Canada. kenneth.rockwood@dal.ca
• Lancet Neurol. 2003 Oct 1; 2 (10): 630-3.

AbstractMetaphor has an important role in the discussion of scientific discovery because it enables researchers to talk about things of which their understanding is incomplete. Alzheimer's disease (AD) can be seen as a journey down a path, which becomes steadily less pleasant and ends in a wholly undesirable destination. To further the metaphor, treatments can be seen as attempts to help the patient return to the starting point, to slow the journey, or to stop at some point on the path. However, treatment may be successful but may not return the patient to their starting point or slow disease progression. We argue that treatments that steer the patient down a different path, to a destination preferable to that at the end of the AD path, can also be seen as successful. This metaphor has practical implications for clinical trials. It highlights the importance of individualised outcome measures that incorporate patients' preferences and should encourage us to develop better means of enabling the recovery of self. To understand how there can be treatment success short of cure, without knowing at the outset what form that success may take, will require systematic observation and careful description of patients' experiences.

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