Alzheimer’s detection is changing. Are we ready to know earlier?

Thanksgiving is around the corner, which often means a surge in patients seeking memory care at the Stony Brook Center of Excellence for Alzheimer’s Disease (CEAD).

Family gatherings often bring us face-to-face with changes in others’ thinking and confusion, says Dr. Nikhil Palekar, Director of CEAD and the Stony Brook Alzheimer’s Disease Clinical Trials Program. “That’s when our phones start ringing.”

What if we didn’t have to wait until memory problems begin, though? New blood-based biomarker tests can detect signs of Alzheimer's more easily, and this might be years before you’d normally get a diagnosis.

But would early screening really benefit everyone? We’re breaking down who should get tested, when, and what we can actually learn from the results.

With climbing Alzheimer's diagnoses (expected to hit nearly 14 million in the US by 2050), earlier detection will support a huge population of at-risk adults. Blood-based Alzheimer's tests—he names the LucentAD p-Tau 217 from Quanterix and PrecivityAD2 from C2N Diagnostics—measure proteins (such as p-tau217) that may indicate the likelihood of Alzheimer’s-related amyloid plaques in the brain.

The Alzheimer's Association now recommends high-performing blood tests as part of clinical evaluation for adults with clear signs of cognitive impairment, alongside cognitive assessment and medical history. Some high-performing blood tests can even substitute for PET scans or cerebrospinal fluid testing,

Yet guidelines “explicitly advise against” blood testing as a means of screening Alzheimer’s in healthy and asymptomatic people, he explains.

If Alzheimer’s pathology starts years before symptoms,

The argument for early testing is that identifying Alzheimer’s-related plaques or biomarkers before physical symptoms might lead to more effective or precise prevention or treatment strategies.

For one, plaques don’t automatically lead to disease. An estimated 20% of people with amyloid plaques may never go on to develop Alzheimer’s while they’re alive.

And if you get a preclinical diagnosis, then what? Whether or not available medications can stop or prevent disease progression in preclinical Alzheimer’s is being studied. (In studies, preclinical [asymptomatic] diagnoses are validated with separate diagnostics like PET scans.)

Say you are a healthy, symptom-free 40-something who wants the test. In this instance, the cost probably also won’t be covered by Medicare or insurance, which likely means paying an estimated $1,400, he explains.

But the positive impact might change for older adults or high-risk individuals. The risk of Alzheimer’s shoots up after 65, and people with two copies of the Apolipoprotein (APOE4) variant have a 10-15x higher risk of developing Alzheimer's than non-carriers.

Dr. Palekar favors blood-based screening for:

This isn’t standard clinical guidance, but it is a new way of thinking about care.

Don’t delay and get evaluated if you are experiencing memory or thinking problems, says Dr. Palekar. Start with a medical evaluation and then consider a blood test. Medicare and some insurance plans sometimes cover it for patients with symptoms.

Focus on maintaining healthy blood pressure, blood sugar, cholesterol, and vitamin D levels, he says. You can get these tested in a routine health screening. Finally, make sure you’re hitting the four pillars of brain health in daily life.

There’s a lot to be hopeful about in the fight against Alzheimer’s. Beyond prevention, researchers are also exploring new angles to tackle the disease.

New treatments: Leqembi (2023) and Kisunla (2024) are two FDA-approved medications that can slow memory decline in early Alzheimer’s by clearing amyloid plaques. Dr. Palekar said patients have had near-complete plaque removal in 12 months. There are still treatment risks, so talk with a doctor first.

An earlier start: Two major clinical trials (AHEAD and TRAILBLAZER-ALZ 3) are looking at the effectiveness of potential medication options in preclinical Alzheimer’s.

Treatment prospects: Researchers are exploring treatments aimed to fight many parts of the disease at once, targeting tau and amyloid and inflammation at once. The hope is that blood-based biomarker testing could one day become an early screening tool.

With emerging Alzheimer’s diagnostics, screening prospects, and lifestyle strategies, earlier diagnosis and treatment are possible. It could mean more time with grandkids, vacations, and many more holidays.

“How awesome is that?” he says.

Have a great day!
Erin

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