Cochrane: Rivastigmine (6 to 12 mg daily orally or 9.5 mg daily transdermally), known as Exelon, appears to be beneficial for people with mild to moderate Alzheimer's disease. In comparisons with placebo, better outcomes were observed for rate of decline of cognitive function and activities of daily living, although the effects were small and of uncertain clinical importance. There was also a benefit from rivastigmine on the outcome of clinician's global assessment. There were no differences between the rivastigmine group and placebo group in behavioural change or impact on carers. At these doses the transdermal patch may have fewer side effects than the capsules but has comparable efficacy. The quality of evidence is only moderate for all of the outcomes reviewed because of a risk of bias due to dropouts. All the studies with usable data were industry funded or sponsored. This review has not examined economic data.
Alzheimer's disease is the commonest cause of dementia affecting older people. As the disease
progresses, people lose the ability to remember, communicate, think
clearly and perform the usual daily activities. Their behaviour or
personality may also change. In severe Alzheimer's disease, the patients lose the ability to care for themselves and require full time care.
Currently, there is no cure available for Alzheimer's disease, but a few pharmacological interventions are available to alleviate symptoms.
The symptoms are caused by the loss of a type of nerve cell in the
brain called cholinergic neurons. Rivastigmine, an acetylcholine
inhibitor, works by increasing the levels of a brain chemical called
acetylcholine which allows the nerve cells to communicate. This may
improve the symptoms of dementia. Rivastigmine can be taken orally, either as capsules or a liquid, or by applying a patch on the skin. Its effectiveness in improving the symptoms of Alzheimer's disease and safety were evaluated in this review.