Progress is being made in moving away from diagnosing dementia solely based on symptoms and going toward a new era of molecular-based diagnosis and disease-modifying treatment. As described in a manuscript published on May 2, 2024 in the periodical Neurology Today, clinicians indicate that advances provide them with new tools to discuss the underlying pathology driving their patients’ cognitive complaints and potential symptoms. It is a time of transition in dementia-related care as the increasing availability of biomarker testing allows for more precise diagnosis and the identification of patients who may benefit from a newly available disease-modifying therapy for Alzheimer’s disease (AD). Clinicians are able to converse with greater clarity with patients about the underlying pathology driving their cognitive complaints and about the expected symptoms patients may see in the future. For example, regarding the question of what is going on in the patient’s brain at the microscopic level, one expert noted that with the availability of anti-amyloid therapies, there is now much more reason to use biomarker proof to answer that query.
The medication Lecanemab, designed to clear amyloid-beta plaque from the brain, received full U.S. Food and Drug Administration (FDA) approval last year for patients with mild cognitive impairment (MCI) or mild dementia with a biomarker-confirmed diagnosis of AD. Another expert asserted that a key question that will have to be resolved is how to define, and in turn explain to patients, biomarker-positive presymptomatic AD, which will likely become a more common scenario as biomarker testing expands—through imaging, cerebrospinal fluid, or blood sampling. Underscoring this perspective is that in a paper published on October 16, 2024 in JAMA Neurology, a team of experts proposed a “new framework for dementia nomenclature.” The authors stated that their recommendations could help guide communication about cognitive impairment among older adults and lead to consistency in the language used in both clinical practice and research. Another salient observation is that the use of biomarker testing and disease-modifying therapy will have to expand to include primary care providers and other community-based doctors because specialty centers will not be able to accommodate the demand for services.