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In Alzheimer\u2019s disease (AD), therapeutic options with proven disease-modifying effects remain limited, despite the recent approval of anti-amyloid monoclonal antibodies. Acetylcholinesterase inhibitors (AChEI), currently classified as symptomatic treatments, have accumulated a number of clinical and experimental evidence suggesting a broader role. Long-term clinical and observational studies indicate that AChEI are associated with slower cognitive and functional decline, reduced hippocampal atrophy, lower mortality rates, and improved behavioral and psychological symptoms of dementia. In parallel, preclinical and clinical data show that AChEI may influence multiple key pathogenic mechanisms of AD, including amyloid-\u03b2 production\/aggregation\/toxicity, neuroinflammation, glutamatergic excitotoxicity, synaptic dysfunction, and cerebral hypoperfusion. 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