AIMS: Cube copying measures visuospatial ability, which is often impaired in Alzheimer's disease (AD). Cube copying was examined as an evaluation of cholinesterase inhibitor (ChEI) treatment in AD. METHODS: Eighty-five ChEI-treated AD patients were included. Cube drawings made at prebaseline, baseline, 6 months, and 12 months were assessed. Cube drawings from 56 healthy individuals were also examined. RESULTS: The healthy individuals remained stable in cube copying, whereas untreated AD patients deteriorated during a median period of 6 months. When treatment was given, the deterioration was interrupted. After 12 months, Mini-Mental State Examination (MMSE) had deteriorated compared with baseline whereas cube copying was unchanged. CONCLUSIONS: The results indicate that cube copying can be used to evaluate ChEI treatment. It might also show a more long-lasting response to treatment than MMSE. Cube copying only measures a narrow cognitive function and can preferably be used with MMSE, which evaluates visuospatial ability poorly.