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Degeneration of human orexinergic neurons across Braak stages of Alzheimer’s disease: Implication for pathogenesis, sleep dysfunction, and therapy

Sleep disturbances are common precognitive symptoms of Alzheimer’s disease (AD). Wake‐promoting orexinergic neurons (Oxe) in the lateral hypothalamic area (LHA) are key regulators of sleep‐wake states. We recently reported a major loss of Oxe in the terminal stages of AD. This was unexpected, because clinical research shows elevated orexin levels in the cerebrospinal fluid (CSF) of AD patients. In line with this finding, suvorexant, an orexin receptor antagonist, was recently the first drug approved for insomnia in patients with mild‐to‐moderate AD. The aim of our current study was to understand the biological basis of these findings and elucidate the still unknown pattern of orexinergic neuron degeneration in the course of AD.