Reactive To Proactive: A Major Shift In The Fight Against Alzheimer's
By Mike Banville
In the early 1990s, my grandmother’s health and cognitive abilities started to decline rapidly. She showed clear signs of dementia, which was most likely Alzheimer’s disease but never received a formal diagnosis.
At the time, testing was limited, and even with a diagnosis, what would have been the point? Knowing more would offer few significant benefits, and no effective treatments would be available.
Fast forward to 2025: around five million Americans are estimated to have Mild Cognitive Impairment (MCI) due to Alzheimer's-related brain changes, according to the Alzheimer’s Association. However, many cases likely remain in diagnostic limbo because of limited access to testing, and patients' reluctance to seek evaluation. Yet, the stakes of early diagnosis have never been higher. Today, groundbreaking therapies exist that that can meaningfully slow the progression of Alzheimer’s disease — if you have a diagnosis.
The arrival of new disease-modifying treatments (DMTs), like Leqembi (lecanemab) and Kisunla (donanemab) are leading to a new era of Alzheimer’s disease treatment and care — one that focuses not just on managing symptoms but on delaying the onset of cognitive decline.
These advanced treatments can address one of the underlying causes of Alzheimer’s disease by reducing amyloid plaque accumulation, slowing disease progression and improving quality of life. However, these therapies are most effective when administered early, before significant damage to the brain has occurred.
A Brief History Of Alzheimer’s Disease Diagnosis
Historically, Alzheimer’s disease diagnosis was largely based on clinical symptoms and cognitive assessments, while Alzheimer’s pathology itself was only confirmed post-mortem. In the past decade, PET imaging scans and cerebrospinal fluid (CSF) testing have evolved together to become the gold standard for Alzheimer’s disease diagnosis, offering highly accurate detection of amyloid plaques and tau tangles, the hallmarks of the condition, which can be present 10 to 15 years before symptoms occur.
However, beyond their diagnostic accuracy, PET imaging and CSF testing face significant barriers, including invasiveness, cost, and the need for specialized resources. CSF testing requires the uncomfortable procedure of a lumbar puncture, while PET scans involve radiation exposure and prolonged motionlessness in a scanner for the patient. Both methods are costly, require up to two hours in a clinical setting, and depend on highly trained specialists and advanced equipment, further limiting accessibility.
These factors present challenges for global access to timely and accurate Alzheimer’s diagnosis, particularly in resource-limited settings. Blood-based tests have been discussed as potentially offering a promising diagnostic alternative to PET scans and CSF tests. They are more affordable, scalable, and easier to administer. However, they previously lacked the precision to consistently diagnose Alzheimer’s disease due to the limited presence of disease markers in the bloodstream. Recent technological advances are now overcoming this challenge, paving the way for more accurate and accessible diagnostics.
These breakthroughs are particularly significant for measuring tau proteins, which play a key role in Alzheimer's disease pathology. Among them, phosphorylated tau 217 (pTau217), has emerged as a highly reliable biomarker for detecting amyloid pathology, a defining feature of the disease. Research shows a strong correlation between pTau217 levels and amyloid PET signal, supporting its use as a blood-based marker for identifying Alzheimer’s pathology even before symptoms appear. Recent advancements in science and technology have enabled the development of highly sensitive blood tests capable of detecting minute levels of pTau217, providing a non-invasive and accessible method for early detection of amyloid with accuracy comparable to PET and CSF testing.
Getting Proactive
The shift toward widespread availability of reliable, affordable, and accurate blood tests represents a pivotal moment in the battle against Alzheimer’s disease. At this time, early detection potentially enables patient access to clinical trials determining the safety and efficacy of early treatment of approved DMTs, shown to deliver the most significant benefits to patients diagnosed early in the progression of the disease.
In addition to being used in clinical trials to test earlier treatment, blood-based tests are expected to allow improved tracking of disease progression and treatment impact, and more effective disease management and care. Early detection also allows families and patients to plan for the future and make lifestyle changes that can help further slow the disease’s progression. Beyond personal benefits, early detection could yield profound economic impacts by reducing costly late-stage care, easing the financial burden on families and healthcare systems.
Shifting From Reactive To Preventative: The Primary Care Physician’s Role
As easily administered blood tests become more available, primary care physicians (PCPs), who serve as the first point of clinical contact for most patients, will play an increasingly crucial role in integrating these tests into standard practice. This shift will help refocus care on prevention, early intervention, treatment, and maintenance, versus long-term care and inevitable decline. Routine screenings for Alzheimer’s disease could become as common as cholesterol checks or glucose tests, allowing for early detection and timely intervention. Taking it a step further, personalized prevention or treatment plans may be formulated based on an individual’s specific biomarker-based results. This shift will require changes to the traditional healthcare infrastructure, including enhanced physician education to support broader access to testing.
The Pharma Potential
While pharmaceutical companies have invested billions in bringing Alzheimer’s disease DMTs to market, the impact of these treatments is minimal without early detection. While the approval of the first DMTs for Alzheimer’s disease marks critical progress, the Department of Brain Health, Chambers-Grundy Center for Transformative Neuroscience, School of Integrated Health Sciences, at the University of Nevada found that these therapies currently achieve approximately a 30% slowing of cognitive decline. To build on this initial success, there is an urgent need to both enhance therapeutic efficacy and intervene earlier in the disease course. As the field shifts toward preventative therapeutics that aim to delay or even prevent the onset of Alzheimer’s in presymptomatic patients, scalable and accessible diagnostic tools become essential. Blood-based biomarkers are key to advancing both goals: earlier detection of preclinical Alzheimer’s disease, when intervention is likely to have the greatest impact, and supporting in the development of more potent therapies by improving clinical trial recruitment and design.
Blood tests have the potential to provide a simple, non-invasive way to monitor disease progression and treatment efficacy over time. Unlike lumbar punctures, patients are more willing to undergo repeated blood tests, making long-term patient management more feasible. The future of Alzheimer’s disease treatment hinges on early diagnosis as much as on new treatments. Had these diagnostic tools and treatments been available during my grandmother’s time, her story and the stories of so many others, might have unfolded differently. Accurate, accessible, and scalable testing is crucial, with blood-based biomarkers leading the way to transform this new era of care from reactive to proactive.
About The Author:
Mike Banville is CEO and President of ALZpath, and has led organizations through a wide range of business stages across sectors including healthcare, higher education, technology and energy. He previously served as CEO at Game Plan, Sensable Health, and SSB, and held executive roles at IHS Markit, including business unit and commercial leadership and global sales strategies. Since his extensive career at IHS Markit, Mike has served as a business builder, leading a myriad of private companies to enable them to scale to the next level, including sales to strategic buyers.