Clinical pathways for cognitively unimpaired individuals with Alzheimer's disease neuropathological change.

Anti-amyloid monoclonal antibodies are clinically meaningful in symptomatic Alzheimer’s disease, and prevention trials are testing them in cognitively unimpaired people with biomarker evidence of AD neuropathological change (ADNC).

• Why it matters: Widespread biomarker testing in cognitively unimpaired individuals raises ethical and downstream consequences, and test accuracy may be challenged by low ADNC prevalence and intermediate biomarker ranges.
• What they did: The work outlines key knowledge gaps for real-world implementation, focusing on how biomarker testing and anti-amyloid treatment would be handled when ADNC prevalence is low or results are uncertain.
• The result: It implies that safe, scalable clinical pathways require evidence on downstream effects and improved interpretation of low-prevalence and intermediate-range biomarker results before routine use.

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