By Marisa Menchola, Ph.D.
For decades, Alzheimer’s disease has been a central focus of public health efforts. Two major changes in how we identify and manage the disease—biomarker-based diagnosis and disease-modifying therapies—are now transforming the lived experience of individuals with Alzheimer’s, their loved ones, and the communities that support them.
The Limits of Waiting for Symptoms
Alzheimer’s disease refers to a specific brain pathology involving abnormal accumulation of beta amyloid and tau proteins that lead to brain dysfunction and eventual atrophy. The symptoms of the disease include cognitive decline such as impaired memory, language, and problem-solving abilities, along with behavioral changes like agitation and apathy. These symptoms typically progress from mild cognitive impairment, during which individuals can function independently, to dementia, when support with daily activities becomes necessary.
In the past, people typically sought evaluation only after significant symptoms emerged. Most often, a concerned family member brought them in following a frightening incident, such as getting lost while driving or making a costly financial mistake. By that point, individuals had often lost awareness of their cognitive decline and might even insist that nothing was wrong.
A major shift in the field involves moving from a focus on symptoms to the use of biomarkers—measurable findings that indicate the presence of disease—for diagnosis. Early biomarkers were limited to imaging tools such as brain MRI and metabolic PET scans. These could reveal brain atrophy or reduced activity in areas commonly affected by Alzheimer’s, but only after substantial damage had occurred. As a result, diagnoses for those who were potentially in the earlier stages of the disease were often tentative and delayed. Families were advised to return for reassessment, and meaningful interventions were limited by the time symptoms became unmistakable.
Biomarker Advancements Lead to Early Detection
The field changed profoundly with the development of imaging tools that could detect the abnormal buildup of beta amyloid and tau. For the first time, clinicians could see the disease itself. Because Alzheimer’s pathology begins decades before cognitive changes emerge, these tools made it possible to identify the disease long before symptoms appeared.
More recently, blood tests that detect Alzheimer’s-related biomarkers have expanded access to early detection. Researchers hope that soon we will detect the earliest signs of Alzheimer’s in a manner similar to how we detect prediabetes through a blood test that measures A1c.
Early detection has reshaped the experience of receiving an Alzheimer’s diagnosis. When people were diagnosed based on symptoms alone, they often could not understand the implications, make decisions about their care, or communicate their preferences. Families were left to interpret or guess their wishes. Biomarker-based diagnosis now allows individuals to participate fully in these essential conversations while they still have clarity and autonomy. This gives care partners greater confidence and peace of mind.
A New Era of Disease-Modifying Therapies
A second transformative change involves the emergence of disease-modifying therapies. These treatments do more than manage symptoms. They effectively rinse amyloid out of the brain and delay cognitive decline. This capability, along with early detection, could lead to Alzheimer’s eventually being managed like other chronic health conditions, preventing cognitive problems before they develop.
The combination of early detection and disease-modifying treatments separates the brain pathology from its symptoms. Increasingly, we will encounter loved ones, coworkers, and neighbors who carry Alzheimer’s pathology yet remain cognitively healthy or experience only mild difficulties. Many will continue to lead active, productive lives for years. As this becomes more common, it is essential to build communities that understand the difference between the disease and a person’s cognitive capacity and that respect the dignity and autonomy of people living with Alzheimer’s disease.
The Opportunity for Meaningful Reframing
Research shows that when people perceive time as limited, they prioritize emotionally meaningful experiences over novelty. They savor moments, prioritize close relationships, pursue purposeful activities, focus on positive experiences, and engage in more prosocial behavior. This shift toward more complex emotions and a deeper appreciation of life occurs in many transitions such as graduations, major moves, or the diagnosis of a serious illness.
When an Alzheimer’s diagnosis comes late, individuals lose the opportunity to experience this meaningful reframing. Even though the disease remains incurable, early diagnosis offers not only more time but time of a different quality. People can live with greater purpose, clarity, and emotional richness.
While we wait for a future when those with Alzheimer’s disease can manage it symptom-free, perhaps the true irony lies in this—that an early diagnosis, once burdened by the stigma of cognitive decline, is emerging as a mark of a life lived wisely.
The Sun Health Memory Care Navigator Program supports individuals and families in connecting with dementia information and resources spanning diagnosis, care, clinical trials, and caregiver support. Help Sun Health provide this critical resource at no cost to additional families by supporting the cause at SunHealthFoundation.org/memorycare.
Dr. Marisa Menchola is a board‑certified clinical neuropsychologist (ABPP‑CN) and associate professor of behavioral sciences at Midwestern University. She earned her Ph.D. at the University of Arizona and completed a postdoctoral fellowship with the Arizona Alzheimer’s Consortium. Her research and advocacy focus on aging, psychology training, and reducing health disparities.
