This review provides an in-depth analysis of the regenerative potential of stem cell-derived exosomes, particularly in the context of neurodegenerative diseases such as Alzheimer's, Parkinson's, and stroke. We explore the mechanisms through which exosomes promote neuronal survival, modulate inflammation, and enhance synaptic plasticity. Furthermore, we evaluate the current landscape of preclinical and clinical studies investigating exosome-based therapies and their implications for future clinical applications. Beyond neuroprotection, stem cell-derived exosomes contribute to neurogenesis, synaptic remodeling, and the restoration of disrupted neural circuits-processes crucial for functional recovery. In stroke models, exosome therapy has been associated with increased neurogenesis in the hippocampus and improved functional outcomes, promoting the formation of new neurons and supporting axonal regeneration. These outcomes highlight the potential for exosome-based therapies to repair damaged neural circuits, facilitating recovery after neurodegenerative diseases and brain injuries.