This comprehensive analysis identifies five key lifestyle interventions that collectively target Alzheimer's pathology through distinct but complementary molecular pathways. Exercise activates BDNF-TrkB signaling and releases neuroprotective myokines like CTSB and IGF-1. Mediterranean and ketogenic diets reduce amyloid-beta deposition while improving mitochondrial function. Intermittent fasting triggers autophagy through AMPK and SIRT3 activation, shifting metabolism toward protective ketone utilization. Quality sleep, particularly slow-wave phases, enhances glymphatic clearance of toxic proteins. Gut microbiome optimization produces beneficial short-chain fatty acids that modulate neuroinflammation. The multimodal approach represents a paradigm shift from single-intervention strategies toward comprehensive lifestyle medicine. While individual interventions show promise, the synergistic effects appear to exceed isolated benefits—a critical insight for prevention-focused neurology. However, significant gaps remain in understanding optimal dosing, personalized protocols for high-risk APOE4 carriers, and long-term efficacy across diverse populations. The framework's strength lies in targeting multiple pathological mechanisms simultaneously, but practical implementation requires standardized protocols and robust longitudinal validation before integration into clinical practice.