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An Alzheimer's Revolution Is Coming, Experts Say
Research roundtable highlights early detection, biomarkers, interventions
An earlier diagnosis and intervention strategy for Alzheimer's disease is on the horizon, signaling a need to overhaul current detection methods and patient care protocols, experts at the Alzheimer's Association Research Roundtable (AARR) said.
"Advances in biomarker technology, digital cognitive assessments, and amyloid-targeting therapies have redefined the opportunities for accurate and early diagnosis and care of Alzheimer's disease," reported Christopher Weber, PhD, of the Alzheimer's Association in Chicago, and co-authors in Alzheimer's & Dementia: Translational Research & Clinical Interventions.
These advances create new possibilities to intervene before the onset of cognitive impairment, Weber and colleagues wrote. Targeting the earliest stages of Alzheimer's, Weber said, "is similar to how doctors treat other diseases like heart disease and some cancers, where early detection and prevention are key parts of care."
Alzheimer's disease often remains undiagnosed until significant memory loss and functional decline have occurred, observed co-author Suzanne Schindler, MD, PhD, of Washington University School of Medicine in St. Louis. "This means that patients and care partners don't get a diagnosis until later in the disease, after the window when interventions are most helpful and patients can make truly independent decisions," she told MedPage Today.
In 2024, an Alzheimer's Association workgroup established new biologically-based criteria for Alzheimer's, incorporating biomarker classifications and a revamped disease staging system. This approach recognized Alzheimer's disease as a process detectable by abnormal biomarkers, even without cognitive symptoms.
The shift wasn't without controversy. A diagnosis based on biomarkers without symptoms sparked debate among clinicians, some of whom argued there may be potential harms to redefining Alzheimer's disease.
In spring of 2025, the AARR convened academic, industry, clinical, and government experts to discuss how to identify and treat people in Alzheimer's earliest stages. "This meeting and paper reviewed the state of the field and areas that need further work, especially if treatments for asymptomatic Alzheimer's are approved in the near future," Schindler said.
Earlier detection brings a set of complex issues, from identifying who's at highest risk and navigating treatment decisions to clear, compassionate communication with patients and families, the AARR said. Stigma and ethical concerns will need to be addressed. Economic, social, and policy factors will need to be considered.
While plasma biomarkers offer hope for broad applications in the clinic, tests must be rigorously validated, the AARR emphasized. Primary care clinicians, who will be on the front lines, will need enhanced tools, training, and support.
Two anti-amyloid therapies currently are approved to treat Alzheimer's patients with mild symptoms -- lecanemab (Leqembi) and donanemab (Kisunla). The AHEAD 3-45 trial of lecanemab and the TRAILBLAZER-ALZ 3 study of donanemab are now testing these drugs in people with biomarker evidence of Alzheimer's who are cognitively intact. "If these studies are successful, it could change how doctors manage the disease," Weber said.
If the trials are successful, it also may create new challenges, noted Eric Widera, MD, of the University of California San Francisco, who was not part of the AARR.
"We struggle currently for people diagnosed with mild cognitive impairment and mild dementia, whether the current treatments equate to a meaningful difference when we see a small but statistically significant difference in the Clinical Dementia Rating-Sum of Boxes," Widera told MedPage Today. "It will be so much more complicated in cognitively unimpaired individuals as it's such a larger population that it will apply to, the measures being studied are not generally outcomes patients truly care about, and it's unclear what a meaningful difference is in these measures."
The consensus that Alzheimer's starts years before symptoms appear has refocused dementia prevention strategies, the AARR pointed out. "Doctors need to learn more about how Alzheimer's disease starts many years before symptoms begin, and also about preventive interventions -- from exercise to hearing aids -- that may reduce the risk of cognitive impairment," Schindler said.
"Research studies, including the U.S. POINTER trial, show that healthy habits with structure and accountability can improve thinking and support brain health in older adults at risk for cognitive decline," Weber added.
This report was supported by the Alzheimer's Association and other groups.
Weber is an employee of the Alzheimer's Association.
Schindler reported serving on scientific advisory boards of biomarker testing and clinical care pathways for Eisai and Novo Nordisk and receiving consultancy/speaking fees for biomarker testing presentations from Eisai, Eli Lilly, and Novo Nordisk.
Co-authors disclosed relationships with nonprofit groups and industry; several were employed full time by pharmaceutical companies.
Widera had no conflicts of interest.
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