What Does a Positive Alzheimer Disease Blood-Based Biomarker Result Mean in People With Mild Cognitive Impairment?

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Blood-based biomarkers expand access to Alzheimer disease diagnostics in community settings but pose challenges integrating into routine care for people with mild cognitive impairment.
Limited evidence exists to guide timing of testing, counselling on dementia progression risk, and selection of evidence-based prevention or treatment strategies for MCI patients.
Authors recommend thorough pretest counselling and prioritise research to close gaps in prognosis, counselling, and management for MCI due to Alzheimer disease.

Neurology. 2026 May 26;106(10):e214953. doi: 10.1212/WNL.0000000000214953. Epub 2026 May 4.

ABSTRACT

Blood-based biomarkers (BBMs) for Alzheimer disease (AD) offer widely expanded access to biomarker-informed diagnoses in community settings that have previously lacked such resources. However, integrating them into current clinical diagnostic practice presents challenges, particularly in the diagnosis of mild cognitive impairment (MCI). Limited data are available to guide clinicians on when to test, how to counsel patients with MCI and a positive AD BBM result about their risk of dementia progression, or which evidence-based dementia prevention strategies or treatments to recommend. This Perspective article outlines the key challenges faced by clinicians and patients when addressing a diagnosis of “MCI due to AD” and offers suggestions for appropriate pretest counseling and future research directions to address current knowledge gaps.

PMID:42081782 | DOI:10.1212/WNL.0000000000214953

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