For decades, an Alzheimer’s disease diagnosis has been viewed as simply a confirmation of a disease, not an opportunity for treatment. Typically, patients or family members would notice subtle changes in memory. Once these symptoms reached the point where concern was raised to a physician, and referrals were made, often leading to months of waiting to see a neurologist, opportunities for even symptomatic treatment were significantly smaller. This diagnosis-to-treatment gap is what I have been focused on resolving for the last 15 years.
The available treatment options for Alzheimer’s disease used to warrant a reactive strategy. There was simply little to no available treatment to manage symptoms. In addition, the increasingly rapid progression of disease and symptoms to the inexorable final stage of severe dementia was inevitable. Thankfully, rapid advancements in diagnostics, biomarker research, and therapies have changed what is possible.
Now is the time for our clinical approach to Alzheimer’s to evolve as well. As clinicians, we would not advocate waiting to reach late-stage cancer before seeking an accurate diagnosis and initiating treatment. The same urgency must now apply to cognitive medicine.
A shift to proactive care
Cancer screenings became the standard of care because it was proven that early evaluation and diagnosis could lead to more positive outcomes. In a time when the Alzheimer’s Association estimates that 7.4 million Americans 65 and older have clinical Alzheimer’s dementia, cognitive decline deserves similar consideration, especially when more of us fear an Alzheimer’s diagnosis than a cancer diagnosis.
Emerging disease-modifying therapies, growing clinical research opportunities, and increasingly sophisticated diagnostic tools have changed the paradigm for Alzheimer’s, but only if we dramatically change the way we provide care. Timing is critical. New early intervention treatments, including FDA-approved amyloid-targeting therapies, are most effective when given as early as possible, when symptoms are still as mild as possible. The most critical time to get an accurate diagnosis and seek treatment is when an individual first detects something is not right with their short-term memory or any other aspect of their thinking ability.
Similar to cancer, when Alzheimer’s is not treated, toxic protein damage spreads through the brain, killing precious brain cells, leading ultimately to severe dementia and death. If detected early, an individual can seek new disease-modifying treatments, either those already on the market or through clinical trials.
What this means for frontline providers
Frontline providers including primary care physicians, internists, and geriatricians are typically the first to learn about a patient’s concerns regarding their memory or cognitive decline. In a busy general practice, conducting comprehensive cognitive workups is not always possible. Even if concerns are brought up early, referral bottlenecks for diagnostic screening can cause major delays. And in many markets across the U.S., access to specialists can be limited. This creates a situation where providers recognize the importance of early evaluation and diagnosis, but the pathways to achieve it are not simple.
The solution is not to expect every provider to build advanced dementia diagnostics at their facilities, but for collaboration to help bridge that gap.
Partnering together for cognitive health
As Alzheimer’s care becomes more specialized, health care providers need trusted referral partners they can rely on who can function as an extension of the care team, working alongside referring clinicians to help diagnose and treat patients with cognitive concerns. This collaboration allows providers to offer their patients timely access to comprehensive cognitive assessments, treatment eligibility evaluations, clinical trial opportunities if appropriate, treatment with amyloid-targeting therapies if eligible, and more. This model is not designed to replace the physician-patient relationship, but to expand what providers can offer their patients.
Like oncology referrals, the goal is to identify concerns, refer efficiently, complete specialized assessments, and coordinate ongoing care collaboratively. When referral paths are difficult and lead to long wait times, evaluation and eventual treatment are delayed. When streamlined, patients get answers and potential options sooner.
The future of Alzheimer’s care: biomarkers and diagnostic innovations
Diagnostic and treatment options have advanced tremendously in recent years, with one of the most promising developments being less invasive diagnostic tools, including blood-based biomarkers. Alzheimer’s diagnostics are becoming faster, more scalable, and more practical, which has great implications for the broader health care community. As screening and diagnostic tools improve, providers will increasingly need referral sources that can act quickly and meet patient needs.
No longer should the response to an Alzheimer’s diagnosis be to monitor and wait until symptoms get worse. Patients now have options, and it is our duty as clinicians to do our best to ensure they have access to them.
The importance of clinical research
Clinical research is an important piece of Alzheimer’s care and should become a more routine part of the conversation after a patient receives a diagnosis. Too often, patients learn about research opportunities only after the disease has progressed beyond the eligibility parameters. Specialty cognitive health providers can identify trial opportunities earlier, giving patients access to innovative treatments while contributing to broader progress in the field.
A call for collaboration
We are currently in a new era of Alzheimer’s care, but no single provider can manage every aspect on their own. The future of cognitive care needs stronger collaboration between primary care physicians, specialists, diagnostic experts, researchers, and dedicated memory health providers. The question is no longer whether early Alzheimer’s detection matters; it is if and how our health care systems are prepared to act on that knowledge.
It is widely accepted that early detection is essential for time-sensitive diseases like cancer. Alzheimer’s should no longer be an exception to this standard of care. Patients deserve answers earlier, and providers deserve pathways to get them those answers. By working together, we can build a new model of care that is proactive, coordinated, and easier for patients to access.
Emer MacSweeney is a world-renowned expert in brain and mind health, including the diagnosis and treatment of Alzheimer’s disease, chronic traumatic encephalopathy (CTE), and other neurodegenerative conditions. She is the cofounder, CEO, and medical director of Re:Cognition Health, which provides a specialist service for the accurate diagnosis and treatment of progressive neurodegenerative and neurodevelopmental conditions, as well as traumatic brain injury, with centers across the United States and the United Kingdom.
A pioneer in Alzheimer’s research and treatment, Dr. MacSweeney has been involved in clinical trials since the early development of therapies for the disease and was the first clinician in Europe to administer the amyloid-targeting therapy Kisunla outside of a clinical trial. She trained in neuroradiology at The Hospital of Neurology and Neurosurgery, Queen Square, London, specializing in interventional vascular neuroradiology, and spent time on scholarship at Harvard University. Her TEDx talk on CTE and contact sports has been viewed more than five million times worldwide.
