This makes the inhibition of the cholinesterase permanent. The cholinesterase gets irreversible phosphorylated according to the following reaction scheme  E + PX <=> E-PX ->[k_3] EP + X   In this reaction scheme the E indicates the cholinesterase, PX the TEPP molecule, E–PX the reversible phosphorylated cholinesterase, "k"3 the reaction rate of the second step, EP the phosphorylated cholinesterase and X the leaving group of the TEPP. The irreversible phosphorylation of the cholinesterase occurs in two steps. In the first step the cholinesterase gets reversibly phosphorylated. This reaction is very fast. Then the second step takes place. The cholinesterase forms a very stable complex with TEPP, in which TEPP is covalently bound to the cholinesterase. This is a slow reaction. But after this step the cholinesterase is irreversibly inhibited. The time dependent irreversible inhibition of the cholinesterase can be described by the following equation. In this formula, "E" is the remaining enzyme activity, "E"0 is the initial enzyme activity, "t" is the time interval after mixing of the cholinesterase and the TEPP, "K""I" is the dissociation constant for cholinesterase-TEPP complex (E–PX) and I is the TEPP concentration. The reaction mechanism and the formula above are both also compatible for other organophosphates. The process occurs in the same way. Furthermore, certain organophosphates can cause OPIDN, organophosphate-induced delayed polyneuropathy. This is a disease, which is characterized by degeneration of axons in the peripheral and central nervous system. This disease will show a few weeks after contamination with the organophosphate. It is believed that the neuropathy target esterase (NTE) is affected by the organophosphate which induces the disease. However, there are no references found, which indicate that TEPP is one of the organophosphates that can cause OPIDN. Acetylcholinesterase inhibitors:   The clinical guidelines for medication management in people with dementia recommend trialing an AChE inhibitor for people with early to mid stage dementia. These guidelines, known as the Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D), suggest that these medicines are at least considered.