Research progress on Gastrodia elata in the prevention and treatment of Alzheimer’s disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder marked by memory loss, cognitive decline, and behavioral dysfunction. Despite increasing prevalence, current therapies, such as acetylcholinesterase inhibitors and NMDA receptor antagonists, provide only symptomatic relief without halting disease progression. The multifactorial pathogenesis of AD, involving β-amyloid (Aβ) aggregation, tau hyperphosphorylation, neuroinflammation, oxidative stress, and gut-brain axis imbalance, underscores the need for multi-target therapeutic approaches. Gastrodia elata (G. elata), known as “Tianma” in traditional Chinese medicinal herb, and its active constituents, mainly gastrodin and gastrodia polysaccharides, have shown promising neuroprotective effects by suppressing neuroinflammatory signaling, enhancing synaptic plasticity, and restoring gut microbiota–brain axis homeostasis against AD through multi-pathway modulation. Therefore, to further deepen the mechanistic understanding, pharmacokinetic characterization, and clinical standardization, this review systematically summarizes preclinical and clinical evidence of G. elata in AD, elucidating its molecular targets and signaling pathways. It also highlights emerging directions—such as network pharmacology, nano-drug delivery, and integrative Chinese-Western medicine strategies—to optimize therapeutic efficacy. By bridging traditional herbal pharmacology with modern systems neuroscience, this review provides a comprehensive framework for understanding the neuroprotective mechanisms of G. elata in AD treatment.