October 20, 2026

@michaelokun

Should we test for Alzheimer's disease before symptoms begin? What resonates with me about this thoughtful JAMA Viewpoint by neurologist Gayatri Devi is the important reminder that just because we can test for Alzheimer's disease does not always mean we should. We are entering an exciting era when blood tests can detect Alzheimer's-related proteins years before memory problems appear, but what do we tell someone who tests positive and may never develop dementia? The article highlights a striking finding: in adults younger than 60 without symptoms, the positive predictive value of one blood biomarker test for detecting amyloid pathology dropped to just 38%. A positive test could create enormous anxiety, affect long-term care or life insurance, and turn an otherwise healthy person into what the author calls a patient-in-waiting. I believe strongly in early detection, and I am excited about the possibility of preventing Alzheimer's before symptoms begin, but we must distinguish detecting abnormal proteins from predicting who will actually develop dementia. Until we have better tools to predict individual risk and proven preventive treatments, we should be cautious about routine testing of folks without symptoms. In the meantime, we already have meaningful actions we can recommend, including exercise, better sleep, controlling blood pressure, addressing hearing loss and staying socially engaged. The goal of medicine should not simply be to identify disease earlier, but to help folks live longer, healthier and better lives. https://cutt.ly/eyRxDMsO