Alpha rhythm and Alzheimer's disease: Has Hans Berger's dream come true?

In this “centenary” paper, an expert panel revisited Hans Berger's groundbreaking discovery of human restingstate electroencephalographic (rsEEG) alpha rhythms (8–12 Hz) in 1924, his foresight of substantial clinical applications in patients with “senile dementia,” and new developments in the field, focusing on Alzheimer's disease (AD), the most prevalent cause of dementia in pathological aging. Clinical guidelines issued in 2024 by the US National Institute on Aging-Alzheimer's Association (NIA-AA) and the European Neuroscience Societies did not endorse routine use of rsEEG biomarkers in the clinical workup of older adults with cognitive impairment. Nevertheless, the expert panel highlighted decades of research from independent workgroups and different techniques showing consistent evidence that abnormalities in rsEEG delta, theta, and alpha rhythms (< 30 Hz) observed in AD patients correlate with wellestablished AD biomarkers of neuropathology, neurodegeneration, and cognitive decline. We posit that these abnormalities may reflect alterations in oscillatory synchronization within subcortical and cortical circuits, inducing cortical inhibitory-excitatory imbalance (in some cases leading to epileptiform activity) and vigilance dysfunctions (e.g., mental fatigue and drowsiness), which may impact AD patients’ quality of life. Berger's vision of using EEG to understand and manage dementia in pathological aging is still actual.