Over the past two decades, there has been increasing research into the molecular composition and function of small extracellular vesicles in the central nervous system. This is due in part to the recognition that small extracellular vesicles likely contribute to the pathogenesis of neurological diseases such as Alzheimer's disease, but also an understanding that small extracellular vesicles are a source of potential biomarkers. Small extracellular vesicles carry specific cargo that reflects their biogenesis and cellular origins, including protein, RNA and lipid. While the protein and RNA content of small extracellular vesicles in the central nervous system diseases and have been studied extensively, our understanding of the lipidome of small extracellular vesicles in the central nervous system is still in its infancy. Lipids play a significant role in maintaining central nervous system structure and function, and the dysregulation of lipid metabolism is known to occur in many neurological disorders, including Alzheimer's disease. Here we review what is currently known about lipid dyshomeostasis in Alzheimer's disease. We propose that small extracellular vesicle lipids may provide insight into the pathophysiology and progression of Alzheimer's disease and other neurological disorders, and, in the future perhaps, aid in disease monitoring and detection.