What Would You Change?
The Diagnostic Breakthrough
On July 28, 2025, the Alzheimer's Association released clinical practice guidelines recommending how specialty clinicians should use blood-based biomarkers (BBMs).
Why this matters: Until now, confirming Alzheimer's disease required either a lumbar puncture (spinal tap) to analyze cerebrospinal fluid or a PET scan. Both are invasive, expensive, and inaccessible to many families. Now, a simple blood test—drawn at your doctor's office, processed by commercial labs—can detect Alzheimer’s pathology with ~90%+ diagnostic performance in peer-reviewed studies (exact performance varies by assay and population). In May 2025, FDA cleared the first blood test measuring plasma p-tau217 and it is now available.
Do you want to know?
The Question No One Is Asking
Doctors are asking:
"Should we order the test?"
Researchers are asking:
"How accurate is it?"
Insurance companies are asking:
"Will we cover it?"
But the most important question for families is:
What would you change if you knew you had Alzheimer's pathology in your brain?
Not "what can be done"—what would YOU do differently?
What It Means to Know
You have Alzheimer's pathology—amyloid plaques and tau tangles—accumulating in your brain right now.
It does NOT mean:
You will definitely develop dementia (some people with pathology never progress)
You will decline rapidly (timeline is unpredictable—could be 2 years, could be 20)
Your fate is sealed (interventions can slow progression)
You should panic
What it DOES mean is that a door has opened to early intervention when new treatments are available and when lifestyle intervention works best. A door to legal planning while you have full capacity. A door to decisions that become more difficult later. A door to preparing your family before crisis.
The New Disease-Modifying Therapies
Lecanemab and donanemab—FDA-approved drugs that slow Alzheimer's progression by about 25%—have strict eligibility requirements:
✅ Mild cognitive impairment OR mild dementia
✅ Confirmed amyloid pathology (requires biomarker test)
❌ NOT moderate or severe dementia
Translation: If you wait until symptoms are obvious, you're likely ineligible. The treatment window closes at moderate dementia.
The Lifestyle Intervention Evidence
The FINGER trial in Finland and US POINTER trial (2025) proved that intensive multi-domain lifestyle interventions can slow cognitive decline. The Lancet Commission (2024) reported 14 modifiable risk factors for dementia. Higher physical activity is associated with slower cognitive and functional decline in individuals with elevated baseline amyloid. Critical finding: Benefits are greatest when started in the MCI stage or earlier. Once moderate dementia arrives, lifestyle interventions are much less effective for patients, but become more important for managing caregiver stress and well-being.
Approaches Providers Can Take Right Now
Approach 1: "Test Everyone with Symptoms"
The problem: Testing without infrastructure to support results. Knowledge without guidance. Diagnosis without stewardship.
Approach 2: "Don't Test Unless It Changes Management"
The problem: Avoidance doesn't prevent progression—it just prevents preparation. The "wait and see" approach guarantees missing treatment windows.
There's a Third Approach: Decision-Preparedness Testing
The question isn't "should we test?" The question is: "What would we do with results?"
"If the test shows Alzheimer's pathology, what would you do?"
Would you pursue disease-modifying therapy?
Would you intensify lifestyle interventions?
Would you accelerate legal and financial planning?
Would you have family conversations about the future?
Would you consider clinical trial participation?
"What are your biggest fears about knowing?"
Anxiety about the future?
Impact on relationships or self-identity?
Discrimination concerns (employment, insurance)?
Not knowing how to act on results?
If your list has 3+ items, have a conversation about testing. Tests are best acted on in specialty care or within a defined care pathway, per the AA guideline.
What To Do Next
If you or a family member has cognitive concerns:
1. Seek Expert Evaluation (Not Just Primary Care Screening)
Primary care doctors are excellent at many things, but detailed cognitive assessment and BBMs interpretation require specialized expertise
See a neuropsychologist, neurologist, or geriatrician with cognitive disorders expertise
Insist on comprehensive evaluation, not just MoCA or MMSE (too insensitive for early changes)
2. Don't Go It Alone
Cognitive decline is a family journey—involve spouse, adult children, trusted friends
Seek services that provide longitudinal support, not just episodic evaluation
Consider programs like Cognitive Stewardship that offer continuous monitoring and decision coaching
3. Act on Results
If biomarker-positive: Immediately begin evidence-based interventions (lifestyle optimization, DMT evaluation if appropriate, advance planning)
If biomarker-negative: Pursue alternative diagnoses and address modifiable factors
Don't let positive results cause paralysis—this is where expert guidance is critical
4. Stay Informed
Biomarker science is evolving rapidly—guidelines will update
Clinical trials are ongoing—opportunities for cutting-edge treatment
New therapies in pipeline—tau-targeting drugs, anti-inflammatory agents, combination therapies
The window for intervention is open. The tools for early detection are here. The question is: Will you use them?
Early Detection Is Only Valuable If Followed by Action
The 2025 Alzheimer's Association guidelines on BBMs represent a pivotal moment in the fight against Alzheimer's disease. For the first time, we can detect pathology early, accurately, and accessibly.
Some experts believe direct-to-consumer or at-home Alzheimer’s blood biomarker testing may be “an innovation too far” — meaning it may cause more harm (anxiety, misinterpretation, unnecessary follow-up tests, discrimination) than benefit in the current state.
They want:
Better care infrastructure: Legal protections against discrimination for biomarker-positive individuals; more clinicians trained in dementia/Alzheimer’s care.
Funding & workforce expansion: More specialists need to be trained and available.
Verified treatments in asymptomatic people: Tests only make sense when there are actionable interventions for people who test positive but do not have symptoms.
This is why I created Cognitive Stewardship. The science of early detection has advanced faster than the clinical infrastructure to support it. Families are getting biomarker results without guidance to know what’s next.
We close that gap.
If you or a loved one has cognitive concerns, or if you've received biomarker results and aren't sure what to do next, Treasure Coast Cognition is here to help.
References
Alzheimer's Association. Appropriate Use of Blood-Based Biomarkers in Alzheimer's Disease: Clinical Practice Guideline From the Alzheimer's Association. Alzheimers Dement. 2025. Published online July 28, 2025. doi:10.1002/alz.14225
Labcorp. Labcorp Launches First FDA-Cleared Blood Test for Alzheimer's Disease. Published May 2025.
Yaffe K, Barnes DE, Rosenberg D, et al. Effect of a Multidomain Lifestyle Intervention vs Health Education on Cognitive Function in Older Adults at Increased Risk of Alzheimer Disease: The US POINTER Randomized Clinical Trial. JAMA. 2025;333(3):217-229. doi:10.1001/jama.2024.24157
Livingston G, Huntley J, Liu KY, et al. Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission. Lancet. 2024;404(10452):572-628. doi:10.1016/S0140-6736(24)01296-0
Rabin JS, et al. Physical Activity and Longitudinal Cognitive and Functional Decline in Alzheimer Disease. Nat Med. 2025. doi:10.1038/s41591-025-03955-6
