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The pathogenesis of Alzheimer's disease (AD) mainly includes the decrease of neurons and synapses, the deposition of the extracellular β⁃ amyloid protein (Aβ), the formation of neuritic plaques (NPs) and neurofibrillary tangles (NFTs) caused by intracellular tau protein hyperphosphorylation. NPs and NFTs are closely related to the brain cholesterol homeostasis imbalance, suggesting that normal brain cholesterol homeostasis may play a decisive role in the development of AD. This paper reviews the molecular regulation mechanism of brain cholesterol homeostasis imbalance in AD.