Many patients with early Alzheimer’s disease (AD) never reach specialist evaluation, representing a critical point of attrition in the care continuum.1 Individuals with mild cognitive impairment (MCI) are often undiagnosed in primary care settings, where time constraints and limited access to cognitive assessment tools result in missed opportunities for intervention.1
Early Alzheimer’s disease frequently presents with complaints beyond memory loss. Patients may report word-finding difficulties, navigation challenges, financial management errors, or executive dysfunction that disrupts complex task completion.1 These symptoms often emerge while basic activities of daily living remain intact, leading to attribution to normal aging rather than pathology. AD and MCI are also commonly identified in patients presenting for unrelated health concerns, emphasizing the importance of diligent screening and clinical attentiveness by clinicians.1 Providing primary care physicians with structured cognitive screening tools such as the Self-Administered Gerocognitive Examination (SAGE) enables systematic evaluation of patients expressing cognitive concerns or demonstrating functional changes reported by family members.3Individual provider training regarding AD and related dementias has also been found to positively associate with patient diagnosis rates.2
The emergence of blood-based biomarker testing offers primary care an additional mechanism for triaging patients who may benefit from specialist referral.4 When cognitive screening suggests impairment, plasma biomarker assays can identify the presence of amyloid pathology, strengthening the case for neurological evaluation and reducing diagnostic uncertainty. This two-step approach (cognitive screening plus biomarker confirmation) provides primary care physicians with confidence in their referral decisions while ensuring neurologists receive patients with higher pretest probability of Alzheimer’s pathology. Additionally, confirmation of amyloid pathology is required for use of disease-modifying treatments (DMTs).4
The Alzheimer’s Association’s recent clinical practice guidelines for provide evidence-based recommendations for blood biomarker use in specialty care settings, with anticipated future guidance on implementation in primary care.5 Expanding accessible testing, establishing clear referral criteria, and communication channels between primary care and neurology practices facilitates accurate and earlier patient identification.4 Neurologists who invest in these relationships through education, shared protocols, and feedback on referred cases contribute to systems that capture patients during the optimal window for disease-modifying intervention. The result is a more efficient care pathway that maximizes the potential of amyloid-targeting therapies to preserve patient independence and quality of life. Additionally, diagnosis of AD during the MCI stage may reduce downstream healthcare utilization and result in a substantial reduction in national health care expenditures.6
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