With new diagnostics and emerging therapies converging, Alzheimer\u2019s disease (AD) care is shifting from late-stage symptom management to earlier intervention. Lynn Kramer, MD, FAAP, Eisai\u2019s Chief Clinical Officer and Head of Clinical Research, discusses what\u2019s driving the change and what comes next.<\/p>\n
Q: The AD landscape has undergone a fundamental shift in recent years, what is driving this change?<\/p>\n
A: There has been a fundamental shift driving urgency across the field as earlier, actionable intervention is becoming possible.<\/p>\n
In addition to the availability of anti-amyloid treatments that may slow disease progression, advances in blood-based biomarkers, neuroimaging, and molecular biology have the ability to detect disease earlier. Amyloid and tau pathology can begin years \u2014 even decades \u2014 before cognitive decline, shifting the field toward earlier diagnosis and intervention rather than just the management of symptoms in the later stages of disease.<\/p>\n
Further, diagnostics and therapeutics are advancing in parallel. This creates a meaningful opportunity to intervene earlier when impact is potentially greatest.<\/p>\n
Q: What do you see as the next frontier in AD?<\/p>\n
A: The field is moving toward a more biologically driven, integrated model of care. In AD, that means aligning diagnostics, biomarkers, and treatments to intervene at the right stage of disease progression.<\/p>\n
A key shift is in how we define disease. Historically, diagnosis has relied on clinical symptoms. Going forward, it will increasingly incorporate biomarker-defined disease, enabling earlier identification and more precise patient stratification.<\/p>\n
Therapeutically, the field is broadening. We now have three years of real-world evidence with anti-amyloid therapy (AAT) from the LEADER study that will be presented at AAIC 2026. And while AATs are foundational, AD is now understood to be multifactorial. There\u2019s growing focus on tau, neuroinflammation, and synaptic dysfunction, with the potential for combination approaches over time.<\/p>\n
Advances in computational modeling and data science are also improving our ability to predict progression and optimize treatment strategies. Together, these developments point toward more proactive and personalized care.<\/p>\n
Q: Blood-based biomarkers have received significant attention. How do they fit into the future of AD diagnosis?<\/p>\n
A: Blood-based biomarkers (BBMs) are one of the most impactful developments in the field, particularly from a clinical scalability perspective. Until recently, confirming the presence of AD pathology required either cerebrospinal fluid (CSF) analysis or amyloid PET imaging. While highly informative, these approaches are not always feasible in routine care due to cost, access, and patient burden.<\/p>\n
BBMs offer a potentially transformative alternative. Biomarkers such as plasma p-tau and amyloid ratios can reflect underlying neuropathology and are often detectable prior to overt clinical symptoms. This creates the possibility of earlier diagnosis at a time when therapeutic intervention may be most beneficial.<\/p>\n
In addition to improving access, BBMs are increasingly demonstrating reliability comparable to established diagnostics. As the evidence base grows, their use in screening, risk stratification, and diagnosis is expected to expand.<\/p>\n
Q: If earlier detection is possible, why are patients still diagnosed late?<\/p>\n
A: The gap between scientific capability and real-world diagnosis is a challenge. Multiple factors contribute to delays, including misconceptions about cognitive decline as a normal aspect of aging, stigma around dementia, and historically complex and time-intensive diagnostic pathways.<\/p>\n
Even as interest in early testing for AD increases, access and awareness remain uneven. In many cases, individuals do not seek evaluation until symptoms become disruptive, by which point significant neuronal damage has already occurred.<\/p>\n
Addressing this gap requires coordinated efforts across the healthcare ecosystem. Primary care providers need practical tools and clear referral pathways, and health systems must integrate new diagnostics efficiently. The Davos Alzheimer\u2019s Collaborative\u2019s Brain Health Navigator program<\/a>, which Eisai supports, is a real-world initiative piloted in U.S. health systems to fix one of the biggest gaps in AD: slow, fragmented diagnosis and care. By piloting a model that actively guides patients from first cognitive concerns through diagnosis and follow-up, we are taking steps towards a more connected, scalable approach to early detection and treatment access.<\/p>\n Q: Why does Alzheimer\u2019s disease matter now?<\/p>\n A: Alzheimer\u2019s disease matters now because early detection, earlier diagnosis, and timely intervention are becoming achievable realities. We have the tools to detect disease earlier and therapies that may slow disease progression. The priority is ensuring these advances translate into real-world impact for patients.<\/p>\n