A Cochrane review included 7 studies with a total of 3450 subjects with mild to moderate Alzheimer’s disease. The mean age was about 75 years.The trials had a duration of between 12 and 52 weeks. The main analysis compared the safety and efficacy of rivastigmine 6 to 12 mg/day orally or 9.5 mg/day transdermally with placebo. After 26 weeks of treatment rivastigmine compared to placebo was associated with better outcomes for cognitive function measured with the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) score (MD -1.79; 95% CI -2.21 to -1.37; 6 studies, n = 3232) and MMSE score (MD 0.74; 95% CI 0.52 to 0.97; 6 studies; n = 3205), activities of daily living (SMD 0.20; 95% CI 0.13 to 0.27; 6 studies, n = 3230) and clinician rated global impression of changes, with a smaller proportion of patients treated with rivastigmine experiencing no change or a deterioration (OR 0.68; 95% CI 0.58 to 0.80; 7 studies, n = 3338). Three studies reported behavioural change, and there were no differences compared to placebo (SMD -0.04; 95% CI -0.14 to 0.06; 3 studies, n = 1529). Only one study measured the impact on caregivers using the Neuropsychiatric Inventory-Caregiver Distress (NPI-D) scale and this found no difference between the groups (MD 0.10; 95% CI -0.91 to 1.11; 1 study, n = 529). Overall, participants who received rivastigmine were about twice as likely to withdraw from the trials (OR 2.01, 95% CI 1.71 to 2.37; 7 studies, n = 3569) or to experience an adverse event during the trials (OR 2.16, 95% CI 1.82 to 2.57; 7 studies, n = 3587).