Inconsistencies and Controversies Surrounding the Amyloid Hypothesis of Alzheimer's Disease
Open accessAbstract
The amyloid hypothesis has driven drug development strategies for Alzheimer's disease for over 20 years. We review why accumulation of amyloid-beta (Aβ) oligomers is generally considered causal for synaptic loss and neurodegeneration in AD. We elaborate on and update arguments for and against the amyloid hypothesis with new data and interpretations, and consider why the amyloid hypothesis may be failing therapeutically. We note several unresolved issues in the field including the presence of Aβ deposition in cognitively normal individuals, the weak correlation between plaque load and cognition, questions regarding the biochemical nature, presence and role of Aβ oligomeric assemblies in vivo, the bias of pre-clinical AD models toward the amyloid hypothesis and the poorly explained pathological heterogeneity and comorbidities associated with AD. We also illustrate how extensive data cited in support of the amyloid hypothesis, including genetic links to disease, can be interpreted independently of a role for Aβ in AD. We conclude it is essential to expand our view of pathogenesis beyond Aβ and tau pathology and suggest several future directions for AD research, which we argue will be critical to understanding AD pathogenesis.
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There is a lack of correlation between plaque load and cognitive decline in AD patients.
“along with the lack of correlation between plaque load and cognitive decline in AD patients3”
From Amyloid-β induces lipid droplet-mediated microglial dysfunction via the enzyme DGAT2 in Alzheimer’s disease (2025) · cites this paper as [3]
In “The Aβ deposition paradox,” the paper says amyloid deposits do not correlate well with cognitive impairment and notes that cognition can decline after amyloid deposition plateaus. Its Figure 3 describes a weak correlation between plaque load and cognition, rather than no correlation at all; the claim overstates that distinction. (LLM, conf=0.84)
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“The weakness of correlation between plaque abundance and cognitive status in humans, along with several unsuccessful clinical trials aimed at preventing cognitive decline by reducing brain A levels, has led some to question the relevance of A in the etiology and progression of AD (Krstic and Knuesel, 2013; Morris et a…”
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- Authors
- Morris, G. P., Clark, I. A., & Vissel, B.
- Affiliations
- Garvan Institute of Medical Research (AU)
- Australian National University (AU)
- Corresponding author
- Vissel, Bryce
- Venue
- Acta Neuropathologica Communications
- Published
- 2014-09-18
- Volume
- 2
- Issue
- 1
- Pages
- 135-135
- ISSN
- 2051-5960 (ISSN-L)
- PMC
- PMC4207354
- OpenAlex
- W2148020885
- Cited by
- 522
- References
- 218
- Citations by year
- 2026: 13 · 2025: 44 · 2024: 47 · 2023: 47 · 2022: 42 · 2021: 41 · 2020: 48 · 2019: 59 · 2018: 63 · 2017: 46 · 2016: 49 · 2015: 22 · 2014: 1
- FWCI
- 26.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Acta Neuropathologica Communications (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Keywords
- amyloid hypothesis, Alzheimer's disease, amyloid-beta oligomers, amyloid plaques, synaptic loss, neurodegeneration, cognitively normal individuals, genetic risk factors, tau pathology, pathological heterogeneity, comorbidities, Alzheimer's disease pathogenesis
- MeSH terms
- Alzheimer Disease, Humans, Synapses, Amyloid beta-Peptides, Neurofibrillary Tangles, tau Proteins, Plaque, Amyloid
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