Acetylcholinesterase is indispensable for terminating acetylcholine-mediated neurotransmission at cholinergic synapses. In addition, there is evidence to suggest that acetylcholinesterase contributes to various physiological processes through its involvement in the regulation of cell proliferation, differentiation and survival. The effects of acetylcholinesterase depend on the cell type and cell-differentiation state, the modulation of expression levels, cellular distribution and binding with its protein partners. This minireview highlights recent progress that has advanced our understanding of the role of acetylcholinesterase in the process of cell proliferation and apoptosis.