In this editorial we have summarised ten years of evidence relating to the use of cholinesterase inhibitors in Alzheimer's and other dementias. We have presented this evidence in the context of the evolution of public and professional awareness of dementia and its management and prescribing patterns over this time frame. We also briefly outline recent political and legal events surrounding the 2007 NICE guidance and the possible long-term impact of cholinesterase inhibitors on clinical practice. Whilst cholinesterase inhibitors continue to play a part in the management of Alzheimer's disease, it is possible that their most important legacy will be their contribution to the increased awareness and recognition of dementia as a neurodegenerative disease and the resulting transformation of old age psychiatry services. Copyright © 2009 John Wiley & Sons, Ltd.