BCHE and neurodegenerative disease: Actovegin and cerebrolysin are animal-derived nootropics, that may havepotential efficacy in the treatment of neurodegenerative disease.133 These agents are used in many countries for conditions such asdementia, stroke and traumatic brain injury, but unlike other drugsconsidered in this guideline (cholinesterase inhibitors and memantine), thenootropics do not have international approval for use in dementia.