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However, its neurophysiological and cognitive effects remain highly variable across studies, underscoring the need for a more integrated mechanistic framework. This review synthesizes current evidence on the neurobiological mechanisms engaged by 40\u2010Hz stimulation in AD, including circuit\u2010, cellular\u2010, and system\u2010level processes underlying network dynamics, glial responses, and multi\u2010target biological effects. We further highlight the conceptual distinction between \u201cphysiological resonance\u201d and \u201cartificial superimposition\u201d as a potential determinant of deep\u2010brain engagement and therapeutic outcomes. By integrating both supportive and conflicting findings, we highlight disease stage, biological sex, and behavioral state as important contributors to the heterogeneity of 40\u2010Hz stimulation outcomes. Building on these observations, we propose that future research should move toward mechanistic stratification and precision neuromodulation to facilitate clinical translation.<\/jats:p>","DOI":"10.1002\/alz.71806","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:11:10Z","timestamp":1788502270000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neurobiological mechanisms of 40\u2010Hz stimulation in Alzheimer's disease: evidence, heterogeneity, and constraints"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8572-3782","authenticated-orcid":false,"given":"Lin","family":"Qi","sequence":"first","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital Zhejiang University School of Medicine  Hangzhou Zhejiang 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