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An often reported finding in the early stage of the disease is the presence of increased functional MRI (fMRI) blood oxygenation level-dependent signal under task conditions relative to cognitively normal controls, a phenomenon known as \u2018hyperactivation\u2019. However, research in the past decades yielded complex, sometimes conflicting results. The magnitude and topology of fMRI hyperactivation patterns have been found to vary across the preclinical and clinical spectrum of Alzheimer\u2019s disease, including concomitant \u2018hypoactivation\u2019 in some cases. These incongruences are likely due to a range of factors, including the disease stage at which the cohort is examined, the brain areas or networks studied and the fMRI paradigm utilized to evoke these functional abnormalities. Additionally, a perennial question pertains to the nature of hyperactivation in the context of Alzheimer\u2019s disease. Some propose it reflects compensatory mechanisms to sustain cognitive performance, while others suggest it is linked to the pathological disruption of a highly regulated homeostatic cycle that contributes to, or even drives, disease progression. Providing a coherent narrative for these empirical and conceptual discrepancies is paramount to develop disease models, understand the synergy between hyperactivation and the Alzheimer\u2019s disease pathological cascade and tailor effective interventions. We first provide a comprehensive overview of functional brain changes spanning the course from normal ageing to the clinical spectrum of Alzheimer\u2019s disease. We then highlight evidence supporting a close relationship between fMRI hyperactivation and in vivo markers of Alzheimer\u2019s pathology. We primarily focus on task-based fMRI studies in humans, but also consider studies using different functional imaging techniques and animal models. We then discuss the potential mechanisms underlying hyperactivation in the context of Alzheimer\u2019s disease and provide a testable framework bridging hyperactivation, ageing, cognition and the Alzheimer\u2019s disease pathological cascade. We conclude with a discussion of future challenges and opportunities to advance our understanding of the fundamental disease mechanisms of Alzheimer\u2019s disease, and the promising development of therapeutic interventions incorporating or aimed at hyperactivation and large-scale functional systems.<\/jats:p>","DOI":"10.1093\/braincomms\/fcae376","type":"journal-article","created":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T15:24:24Z","timestamp":1729697064000},"source":"Crossref","is-referenced-by-count":68,"title":["Cerebral hyperactivation across the Alzheimer\u2019s disease pathological cascade"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6561-9870","authenticated-orcid":false,"given":"Nick","family":"Corriveau-Lecavalier","sequence":"first","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester , Minnesota 55902 ,","place":["USA"]},{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester , Minnesota 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Guericke University Magdeburg , Magdeburg 39120 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7889-795X","authenticated-orcid":false,"given":"Anne","family":"Maass","sequence":"additional","affiliation":[{"name":"German Center for Neurodegenerative Diseases , Magdeburg 39120 ,","place":["Germany"]},{"name":"Institute for Biology, Otto-von-Guericke University Magdeburg , Magdeburg 39120 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,25]]},"reference":[{"issue":"1","key":"2024122016250479700_fcae376-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41572-021-00269-y","article-title":"Alzheimer disease","volume":"7","author":"Knopman","year":"2021","journal-title":"Nat Rev Dis 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