Donepezil, rivastigmine, and galantamine are three drugs with acetylcholinesterase (AChE)-inhibiting activity that are currently being used to treat patients suffering from Alzheimer's disease. We have studied the neuroprotective effects of these drugs, in comparison with nicotine, on cell death caused by -amyloid (A) and okadaic acid, two models that are relevant to Alzheimer's pathology, in the human neuroblastoma cell line SH-SY5Y. Galantamine and donepezil showed a U-shaped neuroprotective curve against okadaic acid toxicity; maximum protection was achieved at 0.3 M galantamine and at 1 M donepezil; at higher concentrations, protection was diminished. Rivastigmine showed a concentration-dependent effect; maximum protection was achieved at 3 M. When apoptosis was induced by A [25][26][27][28][29][30][31][32][33][34][35] , galantamine, donepezil, and rivastigmine showed maximum protection at the same concentrations: 0.3, 1, and 3 M, respectively. Nicotine also afforded protection against A-and okadaic acid-induced toxicity. The neuroprotective effects of galantamine, donepezil, and nicotine were reversed by the ␣7 nicotinic antagonist methyllycaconitine but not by the ␣42 nicotinic antagonist dihydro--erythroidine. The phosphoinositide 3-kinase (PI3K)-Akt blocker 2-(4-morpholinyl)-8-phenyl-1(4H)-benzopyran-4-one hydrochloride (LY294002) reversed the protective effects of galantamine, donepezil, and nicotine but not that of rivastigmine. In contrast, the bcl-2 antagonist ethyl[2-amino-6-bromo-4-(1-cyano-2-ethoxy-2-oxoethyl)]-4H-chromene-3-carboxylate (HA 14-1) reversed the protective effects of the three AChE inhibitors and that of nicotine. Our results show that galantamine, donepezil, and rivastigmine afford neuroprotection through a mechanism that is likely unrelated to AChE inhibition. Such neuroprotection seemed to be linked to ␣7 nicotinic receptors and the PI3K-Akt pathway in the case of galantamine and donepezil but not for rivastigmine.Alzheimer's disease (AD) is a progressive neurodegenerative disease and the most common form of dementia in the elderly population. Clinically, patients with AD show progressive deterioration of all cognitive functions, resulting in their incapacitation. AD is characterized by the presence of two kinds of abnormal protein deposits, amyloid plaques and neurofibrillary tangles (NFTs) in specific areas of the brain, and finally by the atrophy of the affected brain regions, which results from extensive losses of synapses and neurons (Terry et al., 1981(Terry et al., , 1991Price et al., 1991;Arriagada et al., 1992). Amyloid plaques are extracellular deposits containing -amyloid peptide (A) as the major core deposits. A is a 39-to 43-amino acid peptide fragment derived through proteolysis from an integral membrane protein known as A precursor protein. The basis for the -amyloid hypothesis arises from various studies showing that A is toxic to neurons; for example, there is increased A release and apoptotic cell