“…Much less clear in this formulation is how the sleep and wake-dependent accumulation of Aβ in turn disrupts sleep, but AD-related cell death of critical sleep/wake regulatory neurons has been proposed as a possible mechanism (Fronczek et al, 2012; Lim et al, 2014; Manaye et al, 2013). However, sleep symptoms in AD patients often appear before cognitive impairment (Sterniczuk et al, 2013), and at least some transgenic AD mouse models show disrupted sleep phenotypes preceding plaque burden (Huitron-Resendiz et al, 2002; Jyoti et al, 2010; Kollarik et al, 2021; Platt et al, 2011; Roh et al, 2012; Sterniczuk et al, 2010; Wang et al, 2002), even in the absence of neuronal loss (Colby-Milley et al, 2015; Irizarry et al, 1997; Sethi et al, 2015). An alternative hypothesis is that Aβ itself acts as a signalling molecule to modulate sleep and that this normal sleep regulatory process is disrupted in AD progression by changes in Aβ oligomeric state or plaque formation.…”