BCHE and early-onset autosomal dominant Alzheimer disease: Deficits in cholinergic and glutamatergic pathways are involved in cognitive decline in Alzheimer’s disease.138,139 There is also evidence for cholinergic involvement in VCI.140 Cholinesterase inhibitors increase acetylcholine levels by decreasing the rate at which it is broken down, thereby boosting cholinergic neurotransmission.