As the resident macrophages of the brain, microglia are crucial immune cells specific to the nervous system. They continuously monitor the microenvironment and initiate immune responses, playing a key role in various neurodegenerative diseases. During the disease process, microglia exhibit multiple phenotypes, and upon activation, they differentiate into either the pro-inflammatory M1 phenotype or the anti-inflammatory M2 phenotype. Immune regulatory molecules, such as cytokines and chemokines, secreted by microglia, play a pivotal role in shaping brain development, sustaining the neural environment, and mediating responses to injury and subsequent repair processes. However, in recent years, the role of metabolic reprogramming in both normal microglial function and neurodegenerative diseases is also becoming increasingly recognized. Upon activation—triggered by brain injury, infection, or neurodegenerative diseases—microglia typically shift their metabolic pathways from oxidative phosphorylation to glycolysis. This shift facilitates rapid energy production but may also enhance pro-inflammatory responses. This review aims to summarize and discuss the critical roles of metabolic reprogramming and polarization in the function of microglia and their involvement in neurodegenerative diseases.