Alzheimer disease (AD) is accompanied by a marked loss of acetylcholinesterase (AChE) activity associated with cortical cholinergic axons and cholinoceptive neurons. Simultaneous with this loss, cholinesterase (ChE) activity emerges in AD cortex in the form of AChE and butyrylcholinesterase activity associated with plaques, tangles, and amyloid angiopathy. Our observations have shown that the ChEs associated with the pathological lesions of AD (ADChEs) possess different enzymatic properties and quite possibly are of a different source as compared with the ChEs associated with normal neurons and axons. The ADChEs most likely have noncholinergic functions involved in the pathogenesis of AD. The postulated functions include acting as proteases/peptidases, participating directly in the amyloidogenic processing of the amyloid precursor protein, and causing aberrant growth of neuronal processes. The therapeutic and diagnostic implications of ADChEs are discussed.