Alpiniae oxyphyllae Fructus (Zingiberaceae; Alpinia oxyphylla Miq) (AOF) is a traditional Chinese medicinal and edible homologous material rich in bioactive metabolites, including flavonoids, terpenes, and sesquiterpenes. Its multiple metabolites and multi-target nature confer unique advantages for cognitive function and neuroprotection. However, recent advances in extraction techniques, the discovery of AOF effects, and novel ameliorative mechanisms against Alzheimer's disease (AD) require an updated review. This review systematically expands on the botanical features, traditional dietary applications, and quality control of AOF raw materials, as well as its AD-ameliorating effect, in vivo absorption, toxicological safety, and extraction technology optimization strategies. Moreover, we explored the emerging mechanisms underlying the effectiveness of AOF and its bioactive metabolites in improving AD, including effects on glial cell function, the gut-brain axis, brain metal ions, and advanced glycation end products. This review comprehensively summarizes preclinical studies, clinical research, and commercially available products related to AOF and its metabolites. It also expounds upon the potential impetus that artificial intelligence could offer AOF research in the future. In summary, this review provides innovative technologies, in-depth mechanistic analyses, and novel research directions for exploring AOF extracts and their bioactive metabolites to offer strategic guidance for identifying new functional factors and drug candidates to combat AD.
