To treat Alzheimer’s, first we must diagnose it

There’s one image around Alzheimer’s that comes into my mind almost daily. At Alzheimer’s Association walks, participants each carry a flower whose color reflects their relationship with the disease, creating a sea of blue, yellow, purple and orange. Finally, a child carries a single white flower representing the first person to be cured of Alzheimer’s, in hopes that one day we will be able to plant it.

I get emotional just thinking about it. Especially because finally, we have a chance to make this extraordinary vision a reality.

For the first time ever, we have an approved, disease-modifying therapy that can slow the progression of the plaques associated with the disease. We are now entering a world where an Alzheimer’s diagnosis isn’t the end of the road, but the beginning of a course of treatment. After more than 25 years of tireless investigation, testing and learning, this moment feels like a dream.

But now we are suddenly facing a firehose of new questions. How will we ensure this treatment gets to people who need it? Who will pay for the drug, which may be prohibitively expensive for many? And at the very beginning of the chain: how will we diagnose the growing number of people we anticipate will experience dementia so they can get the treatment in time to make a difference?

Our current diagnostics for Alzheimer’s are limited to two options. A PET scan can look for plaques in the brain, but for many, the long trips into cities where these few centers reside make them inaccessible.  A spinal tap can be used to look for hallmarks of Alzheimer’s plaques in spinal fluid, but this is an invasive and frightening procedure for many patients – hardly an incentive to test early. While effective, both options are costly, and most people only seek them out when their symptoms are advanced.

Until very recently, there hasn’t been much need to press for better or more accessible diagnostics. Without meaningful therapeutic options, the most tangible outcome of a positive test result has been limited to working with a neurologist or therapist to adjust behaviors to slow the impact of inevitable cognitive decline. But now, efforts are quickly spinning up to match our diagnostic capabilities to our treatments.

One compelling vision is a blood test, since it’s minimally invasive and testing centers across the country are well equipped to handle processing and testing blood. But there are significant challenges to looking for disease markers in blood. Spinal fluid flows directly from the brain, so the concentration of markers there is high. In blood, they’re significantly reduced and therefore much harder to detect.

One of our diagnostics companies, Beckman Coulter, is working on the scientific side of this problem with a new system that can unlock 100 times the sensitivity compared to previous immunoassay platforms. Immunoassay is a proven, versatile technology used to analyze blood for a wide variety of biomarkers, including cardiac, diabetes, fertility, tumor markers, infectious disease and others. Current state-of-the-art heart attack immunoassay diagnostics can detect the equivalent of a teaspoon of sugar in a thousand Olympic swimming pools; our latest innovation targets Alzheimer’s biomarkers to measure that same teaspoon in 100,000 pools. With improved sensitivity, we can imagine a world where it’s used to detect many other biomarkers at ever smaller concentrations – including early signs of Alzheimer’s.

Powerful instruments in community laboratories are just one critical component of making Alzheimer’s diagnosis and treatment a reality. Worldwide, at least 55 million people are currently believed to be living with Alzheimer's disease or other dementias, including over six million Americans. That number is estimated to rise to 152 million by 2050. The economic toll of the disease is staggering: in 2022, Alzheimer's cost the U.S. economy an estimated $321 billion, in addition to an estimated $271 billion in unpaid caregiving. By 2050, the number of Americans living with Alzheimer’s is expected to reach 12.7 million, bringing the total cost to nearly $1 trillion each year.

If our meetings with government leaders, biopharma leaders, and lab operations decision-makers have reinforced anything, it’s that we are facing a multifaceted problem that will require a vast, coordinated effort to solve. If every patient who thought they had Alzheimer’s contacted their neurologist tomorrow, our infrastructure simply wouldn’t be prepared to help. But the earlier we can diagnose the disease – and the simpler that diagnostic is both for patients and providers – the more we can ensure that treatments are both effective and accessible to everyone, not just the privileged few.

Outside the window of my home, spring flowers are pushing through the soil. It has been a long winter for countless people impacted by Alzheimer’s, from the patients themselves to the friends, family members, caregivers and healthcare providers whose lives become defined by the disease. Each white blossom reminds me of all the work our scientists, advocacy organizations and healthcare organizations have done to plant the seeds of this moment, and the sense of duty all of us in diagnostics share to do everything we can to ensure they thrive.