Synthesis of acetylcholine requires acetyl-coenzyme A which donates an acetyl group to choline. With dysregulation of the transsulfuration pathway in Alzheimer’s disease, marked by high levels of homocysteine, L-cysteine is not synthesized at sufficient levels. See my paper A disease-modifying treatment for Alzheimer’s disease: focus on the trans-sulfuration pathway. With low levels of l-cysteine coenzyme A, which is synthesized from pantothenic acid and which requires l-cysteine for synthesis, is not synthesized at appropriate levels. With low levels of coenzyme A the E2 subunit of the pyruvate dehydrogenase complex is underactive. Acetyl-coenzyme A required for the synthesis of acetylcholine is derived from the pyruvate dehydrogenase complex. Dysregulation of the pyruvate dehydrogenase complex could lead to shortages of acetylcholine in Alzheimer’s disease. Shortages of acetylcholine are a hallmark of Alzheimer’s disease. Supplementation with pantothenic acid and sulbutiamine, a fat-soluble thiamine derivative, could improve symptoms of Alzheimer’s disease due to acetylcholine deficiencies such as poor memory. There is a lot askew in Alzheimer’s disease so supplementation with pantothenic acid and sulbutiamine would only be partly effective in Alzheimer’s disease. As always various supplements must be avoided. See the Treatment page on what supplements to avoid.