Alzheimer's disease (AD) is a complex disease of the brain. Despite over 100 years of basic and clinical research, significantly intensified in the last three decades, the exact cause of this neurodegeneration is still an enigma. Based on neuroanatomical, experimental, and clinical findings, a series of hypotheses on AD pathogenesis have evolved. Among them, the “amyloid cascade hypothesis” has been most prominent. Clinical efforts targeting the biochemistry of amyloid β-protein (Aβ) as causal therapy have all failed so far, which may mean that the pathogenic mechanism of AD is less straightforward than initially thought. While there was good scientific reason to support this hypothesis before, the exclusive concentration on it may have impeded a more objective look and prevented the pursuit of alternative approaches to decipher the cause of AD. Here, a few key hypotheses of AD are summarized, and it is proposed that our view of the cause (or causes) of this detrimental disease be widened. This includes looking back, reactivating, and revisiting findings that were ignored over the last decades. Alternative and amyloid-independent ways to explain AD pathogenesis should receive more attention and are appearing.

阿尔茨海默病 (AD) 是一种复杂的大脑疾病。尽管已有 100 多年的基础和临床研究，在过去的 30 年中显着加强，但这种神经变性的确切原因仍然是一个谜。基于神经解剖学、实验和临床发现，已经形成了一系列关于 AD 发病机制的假设。其中，“淀粉样蛋白级联假说”最为突出。迄今为止，针对淀粉样蛋白 β 蛋白 (Aβ) 的生物化学作为病因治疗的临床努力都失败了，这可能意味着 AD 的发病机制并不像最初想象的那么简单。虽然之前有充分的科学理由支持这一假设，对它的完全关注可能阻碍了更客观的观察，并阻止了寻求其他方法来破译 AD 的原因。在这里，总结了 AD 的一些关键假设，并建议拓宽我们对这种有害疾病的原因（或多个原因）的看法。这包括回顾、重新激活和重新审视过去几十年被忽视的发现。解释 AD 发病机制的替代性和非淀粉样蛋白依赖性方法应该受到更多关注并正在出现。