The relationship between engagement in pleasant activities as rated by the patient and as rated by the caregiver from the patient's perspective was examined using structural equation modeling in a sample of patients (N = 277) diagnosed with mild to moderate Alzheimer's disease. The two activity participation ratings were only moderately related to one another. Furthermore, depression was the only significant predictor of the patient-rated activity participation, whereas severity of depression, degree of personality change, level of dependence, and cognition were all significant predictors of caregiver-rated activity participation. These findings suggest that caregivers consider a wider range of variables when evaluating the patient's engagement in activities than does the patient. Predictors of patient-rated activity participation did not differ as a function of age or cognition.