A growing body of evidence indicates that hypoglycemia and acidosis may contribute to the development of Alzheimer's disease (AD). The cell death of basal forebrain cholinergic neurons constitutes a hallmark of AD and directly correlates with cognitive impairment. The aim of the present study was to investigate, in an organotypic rat brain slice model of the basal nucleus of Meynert, the effects of glucose deprivation on cholinergic neurons under normal and acidic conditions. Furthermore, we were interested to explore whether different saccharides (galactose, fructose, saccharose, lactose) can replace glucose under low pH conditions. Our data show a pH-dependent survival of cholinergic neurons at a high (37.1 mmol/l) glucose level, which was markedly decreased at a low (5.6 mmol/l) glucose level. Galactose (+31.5 mmol/l) significantly counteracted the loss of choline acetyltransferase-positive neurons in low-glucose-treated slices, while fructose, lactose and saccharose only partly protected cholinergic neurons. In conclusion, our results indicate that replacement of glucose with different saccharides, but most potently with galactose, protects cholinergic neurons against hypoglycemia at a low pH.