With population aging worldwide, Alzheimer’s disease (AD) has become a serious human health issue. Owing in part to the complexity of the pathogenesis of AD, effective therapeutic options are lacking. Mesenchymal stem cell-derived exosomes (MSC-Exos) have powerful regenerative properties and repair functions, providing a new direction for treatment. They are donor-derived, easily stored, natural carriers, with low immunogenicity and a low risk of tumor formation. They have shown great potential in the treatment of AD and post treatment rehabilitation. This article introduces the pathological mechanisms of AD and characteristics of MSC-Exos, provides a detailed review of the roles of MSC-Exos in the treatment of AD, including anti-inflammatory effects,immunomodulatory effects, and related signaling pathway modulation, and summarizes recent research progress, with the aim of providing a basis for the development of novel therapeutic approaches to AD.