To investigate the expression and clinical significance of microRNA-146a, Aβ1-42, and tau protein in the peripheral blood of patients with Alzheimer's disease (AD). A total of 98 AD patients admitted to our hospital were selected as the experimental group and 50 healthy individuals were selected as the control group. The correlations between microRNA-146a, Aβ1-42, and tau protein were analyzed using receiver operating curves to evaluate the value of microRNA-146a in predicting AD. Bioinformatics analysis was performed to preliminarily explore the possible mechanisms of microRNA-146a in the pathogenesis of AD. MicroRNA-146a, Aβ1-42 and tau protein were differentially expressed between AD patients and healthy individuals (p<0.05). microRNA-146a was negatively correlated with Aβ1-42 (r=-0.882, p<0.05) but was not correlated with tau protein (p>0.05). The ROC curve showed that the area under the curve for microRNA-146a could be used to predict AD with an accuracy of 0.879 (95% CI 0.812-0.947). Bioinformatics analysis showed that the differentially expressed genes (DEGs) of microRNA-146a may be involved in the pathogenesis of AD through the regulation of multiple signaling pathways, including the Toll-like receptor signaling pathway, the neurotransmitter regulatory signaling pathways, and other pathways that affect the inflammatory response, synapse formation, and other biological processes. MicroRNA-146a, Aβ1-42 and tau protein are differentially expressed in the peripheral blood of AD patients. These proteins may be involved in the pathogenesis of AD by regulating the activity of multiple signaling pathways and the expression of the Aβ1-42 protein.