Digital, Blood-Based Innovations Transform Alzheimer Disease Detection: Ken Cohen, MD, FACP

As digital and blood-based screening tools emerge, Alzheimer disease (AD) detection is becoming more accessible and accurate than ever, explains Ken Cohen, MD, FACP, executive director of translational research, Optum Health. These groundbreaking innovations can streamline early diagnosis and care, and even spark complex conversations about patient anxiety, privacy, and the value of knowing one’s risk.

This transcript has been lightly edited; captions were auto-generated.

Transcript

With new blood-based and digital screening tools emerging, how do you see innovation shaping the future of AD detection?

That's a fascinating question. In terms of the digital tools for cognitive assessment, ideally, these would be done in the home prior to the visit. Just as a matter of efficiency, so patients can arrive with their cognitive score. I think that would be helpful, but I think the discussion around biomarkers is really the most important discussion. By and large, patients aren't familiar with these at all, and frankly, primary care physicians are just becoming familiar with them. They have a huge benefit in that they are highly accurate in making a diagnosis of Alzheimer disease. They can supplant very expensive Alzheimer PET scans with what appear to be equal diagnostic accuracy, so clearly they play a role.

They also have the potential to engender a huge amount of anxiety for patients in terms of anxiety about future cognitive decline, what friends and families will perceive, privacy issues, and very often, patients still view the treatment options as limited and therefore question if there is value in making a diagnosis for a disease for which there is limited therapy. There's a lot of push and pull in this discussion in terms of things that are clearly of benefit but things that cause anxiety for patients as well. We have not positioned screening up front.

Where we have positioned the biomarker screening, specifically the pTau217, is once a diagnosis of cognitive decline has been made, we then stage the degree of cognitive decline, and if patients have moderate to severe disease, we put them directly into a care management program. But if they have MCI [mild cognitive impairment] or mild disease, that's where we have a conversation with them about the availability of monoclonal antibody therapy. If they are considering monoclonal antibody therapy, that's the point at which we get a pTau217 to make certain that we've established the correct diagnosis. We also do an APOE4 [apolipoprotein E4] at that point, because we know that individuals who have a homozygosity for APOE4 have a much higher incidence of hemorrhage and edema with the monoclonal antibodies. That also has to go into the informed decision-making around which patients should be treated or not treated.