Acetylcholinesterase (AChE), an enzyme responsible for the break-down of acetylcholine, is found both in cholinergic and non-cholinergic neurons in the central nervous system. In addition to its role in the catabolism of acetylcholine, AChE have other functions in brain, e.g. in the processing of peptides and proteins, and in the modulation of dopaminergic neurons in the brain stem. Several clinical and experimental studies have investigated AChE in brain and cerebrospinal fluid (CSF) in aging and dementia. The results suggest that brain AChE and its molecular forms show interesting changes in dementia and aging. However, CSF-AChE activity is not a very reliable or sensitive marker of the integrity and function of cholinergic neurons in the basal forebrain complex. Additional work is needed to clarify the role of AChE abnormality in the formation of pathology changes in patients with Alzheimer's disease.