{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T20:37:16Z","timestamp":1787690236602,"version":"build-2784847793"},"reference-count":61,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Alzheimer\u2019s Disease"],"published-print":{"date-parts":[[2021,2,2]]},"abstract":"<jats:p>Amyloid-\u03b2 (A\u03b2) and tau oligomers have been identified as neurotoxic agents responsible for causing Alzheimer\u2019s disease (AD). Clinical trials using A\u03b2 and tau as targets have failed, giving rise to calls for new research approaches to combat AD. This paper provides such an approach. Most basic AD research has involved quiescent A\u03b2 and tau solutions. However, studies involving laminar and extensional flow of proteins have demonstrated that mechanical agitation of proteins induces or accelerates protein aggregation. Recent MRI brain studies have revealed high energy, chaotic motion of cerebrospinal fluid (CSF) in lower brain and brainstem regions. These and studies showing CSF flow within the brain have shown that there are two energetic hot spots. These are within the third and fourth brain ventricles and in the neighborhood of the circle of Willis blood vessel region. These two regions are also the same locations as those of the earliest A\u03b2 and tau AD pathology. In this paper, it is proposed that cardiac systolic pulse waves that emanate from the major brain arteries in the lower brain and brainstem regions and whose pulse waves drive CSF flows within the brain are responsible for initiating AD and possibly other amyloid diseases. It is further proposed that the triggering of these diseases comes about because of the strengthening of systolic pulses due to major artery hardening that generates intense CSF extensional flow stress. Such stress provides the activation energy needed to induce conformational changes of both A\u03b2 and tau within the lower brain and brainstem region, producing unique neurotoxic oligomer molecule conformations that induce AD.<\/jats:p>","DOI":"10.3233\/jad-201025","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T11:05:12Z","timestamp":1609239912000},"page":"979-1002","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Shear-Induced Amyloid Aggregation in the Brain: V. Are Alzheimer\u2019s and Other Amyloid Diseases Initiated in the Lower Brain and Brainstem by Cerebrospinal Fluid Flow Stresses?"],"prefix":"10.1177","volume":"79","author":[{"given":"Conrad N.","family":"Trumbore","sequence":"first","affiliation":[{"name":"Department of Chemistry and Biochemistry, University of Delaware, Newark, DE, 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