Cited by 69Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

The Cause of Alzheimer’s Disease: The Theory of Multipathology Convergence to Chronic Neuronal Stress

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Decourt, Boris, D’Souza, Gary X, Shi, Jiong, Ritter, Aaron, Suazo, Jasmin, Sabbagh, Marwan N·2022·Aging and disease

Abstract

The field of Alzheimer's disease (AD) research critically lacks an all-inclusive etiology theory that would integrate existing hypotheses and explain the heterogeneity of disease trajectory and pathologies observed in each individual patient. Here, we propose a novel comprehensive theory that we named: the multipathology convergence to chronic neuronal stress. Our new theory reconsiders long-standing dogmas advanced by previous incomplete theories. Firstly, while it is undeniable that amyloid beta (Aβ) is involved in AD, in the seminal stage of the disease Aβ is unlikely pathogenic. Instead, we hypothesize that the root cause of AD is neuronal stress in the central nervous system (CNS), and Aβ is expressed as part of the physiological response to protect CNS neurons from stress. If there is no return to homeostasis, then Aβ becomes overexpressed, and this includes the generation of longer forms that are more toxic and prone to oligomerization. Secondly, AD etiology is plausibly not strictly compartmentalized within the CNS but may also result from the dysfunction of other physiological systems in the entire body. This view implies that AD may not have a single cause, but rather needs to be considered as a spectrum of multiple chronic pathological modalities converging to the persistent stressing of CNS neurons. These chronic pathological modalities, which include cardiovascular disease, metabolic disorders, and CNS structural changes, often start individually, and over time combine with other chronic modalities to incrementally escalate the amount of stress applied to CNS neurons. We present the case for considering Aβ as a marker of neuronal stress in response to hypoxic, toxic, and starvation events, rather than solely a marker of AD. We also detail numerous human chronic conditions that can lead to neuronal stress in the CNS, making the link with co-morbidities encountered in daily clinical AD practice. Finally, we explain how our theory could be leveraged to improve clinical care for AD and related dementia in personalized medicine paradigms in the near future.

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Authors
Decourt, B., D’Souza, G. X., Shi, J., Ritter, A., Suazo, J., & Sabbagh, M. N.
Affiliations
  • Cleveland Clinic (US)
  • Rush University Medical Center (US)
  • Lou Ruvo Brain Institute (US)
Corresponding author
Decourt, Boris
Venue
Aging and disease
Published
2022
Volume
13
Issue
1
Pages
37
ISSN
2152-5250 (ISSN-L)
OpenAlex
W4206904628
Cited by
69
References
206
Citations by year
2026: 13 · 2025: 17 · 2024: 17 · 2023: 14 · 2022: 8
FWCI
8.66
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Aging and Disease (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institute on Aging (P20AG068053, R01AG073212, R01AG059008, K01AG047279)
  • National Institute of General Medical Sciences (P20GM109025)
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-beta, amyloid oligomerization, hypoxia, metabolic stress, cardiovascular comorbidity, metabolic disorders, dementia, personalized medicine, disease heterogeneity

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