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Curr Pharm Des. 2019;25(33):3519-3535. doi: 10.2174/1381612825666191008103141.

Cholinesterase Inhibitors for Alzheimer's Disease: Multitargeting Strategy Based on Anti-Alzheimer's Drugs Repositioning.

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Department of Pharmacy, BRAC University, Dhaka, Bangladesh.
Department of Pharmacy, Southeast University, Dhaka, Bangladesh.
Pharmakon Neuroscience Research Network, Dhaka, Bangladesh.
Department of Pharmacy, East West University, Dhaka, Bangladesh.
Department of Zoology, Bharathiar University, Tamil Nadu, India.
Graduate School of Innovative Life Science, University of Toyama, Toyama, Japan.
Chrono-Environnement Laboratory, CNRS 6249, Bourgogne Franche-Comté University, Besançon, France.
Division of Drug Design and Medicinal Chemistry Research Lab, Department of Pharmaceutical Chemistry, Ahalia School of Pharmacy, Palakkad, India.
Department of Pharmacy, Daffodil International University, Dhaka, Bangladesh.
Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile.
King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.


In the brain, acetylcholine (ACh) is regarded as one of the major neurotransmitters. During the advancement of Alzheimer's disease (AD) cholinergic deficits occur and this can lead to extensive cognitive dysfunction and decline. Acetylcholinesterase (AChE) remains a highly feasible target for the symptomatic improvement of AD. Acetylcholinesterase (AChE) remains a highly viable target for the symptomatic improvement in AD because cholinergic deficit is a consistent and early finding in AD. The treatment approach of inhibiting peripheral AChE for myasthenia gravis had effectively proven that AChE inhibition was a reachable therapeutic target. Subsequently tacrine, donepezil, rivastigmine, and galantamine were developed and approved for the symptomatic treatment of AD. Since then, multiple cholinesterase inhibitors (ChEIs) have been continued to be developed. These include newer ChEIs, naturally derived ChEIs, hybrids, and synthetic analogues. In this paper, we summarize the different types of ChEIs which are under development and their respective mechanisms of actions.


Acetylcholine; Alzheimer’s disease; acetylcholinesterase inhibitors; donepezil; galantamine; rivastigmine; tacrine.

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