Advances in Alzheimer’s disease (AD) biomarker testing are rapidly reshaping clinical practice and patient expectations. Amyloid PET scans, cerebrospinal fluid analysis, and plasma-based blood tests now allow clinicians to detect biological signatures of AD pathology. While these tests promise earlier detection and have enabled groundbreaking and welcomed disease-modifying prescription drug treatments, such as lecanemab and donanemab, their clinical adoption has outrun the development of ethical safeguards and provider education that would equip care systems to manage their psychological consequences responsibly. This is especially concerning as these tests increasingly enter primary care settings (Hansson et al., 2024), often following direct patient requests after media coverage, with results offered in a portal with no clinical interpretation or next-step guidance. ABPP-certified psychologists are uniquely positioned to advocate for ethically grounded protocols ensuring results are interpreted within clinical context, not as stand-alone diagnostic shortcuts.
A Terrifying Possibility
According to the Alzheimer’s Research UK Dementia Attitudes Monitor (2025), half of adults polled fear dementia more than any other condition, rising to 59% among those 65 and older. The World Alzheimer Report (2019) found nearly 80% of respondents across 54 countries expressed similar concerns. Older adults are barraged by marketing campaigns promoting biomarker testing as essential for proactive brain health. Pharmaceutical companies have invested billions in promoting disease-modifying treatments and stimulating demand for diagnostic testing. Pharmaceutical company Eisai has placed direct-to-consumer advertising at the heart of its U.S. strategy, launching targeted TV campaigns for lecanemab. In 2023, Quest Diagnostics launched a $399 consumer-initiated blood test, available without a physician visit. These campaigns emphasize early testing while providing inadequate context about appropriate candidates. Biomarker testing should be part of comprehensive clinical workup, not stand-alone screening purchased in response to fear-based marketing.
Biomarker Studies Test for Amyloid not Alzheimer’s Disease
For the first time in history, the dementias are being marketed directly to the public as having a simple diagnostic answer. This represents a profound shift in how we communicate about dementia. For generations, the public has held tightly to the understanding that dementia can only be diagnosed at autopsy. What is not nearly as well known is Stern’s insights about cognitive reserve that demonstrated that 25% to 67% of individuals meeting autopsy criteria for AD were nondemented throughout longitudinal assessments (Stern, 2012). At minimum, one in four people testing positive on biomarkers would test negative on neuropsychological evaluation. Perhaps most insidiously, treating probabilistic data as diagnostic certainty promotes premature labeling. Biomarkers indicate biological risk, not clinical destiny. When patients interpret positive tests as confirmation of “having Alzheimer’s,” they conflate risk with syndrome, potentially triggering unnecessary life-altering decisions and even suicide, with risk elevated 2.5-fold in the first year following diagnosis (Choi et al., 2021; Schmutte et al., 2022). This false certainty is compounded by interassay variability and lack of standardized cutoffs (Pleen et al., 2024).
In contrast, the predictive validity of neuropsychological testing, differentiating Alzheimer’s dementia from non-dementia with nearly 90% accuracy, is not nearly as well known. Perpetuating this fact staying unknown in public discourse is that access to neuropsychological evaluation involves substantial wait times that consistently present barriers to timely care. In the United States, the average wait for neuropsychological testing is estimated at 5 to 10 months for adults, with some clinics reporting waits of 6 to 7 months for memory-related assessments. In the United Kingdom, the National Audit of Memory Assessment Services found that average wait times from referral to dementia diagnosis increased from 13 weeks in 2019 to 18 weeks in 2021, with individual services ranging from immediate access to 104 weeks. Australian data reveal even longer delays, with an average of 3 years between initial symptom report and formal dementia diagnosis, extending to 7 years for those with young-onset dementias. These access barriers create fertile ground for direct-to-consumer biomarker tests that promise results within days, and slick marketing campaigns now suggest that a blood test can provide the answers families desperately seek. This oversimplification threatens to replace nuanced clinical understanding with false certainty, leaving patients and families unprepared for the probabilistic nature of biomarker results.
The Psychological Cost of False Certainty
The psychological consequences of biomarker disclosure warrant serious attention. While controlled studies suggest disclosure does not produce clinically significant anxiety or depression short-term (Schaar et al., 2023), these findings require cautious interpretation. Such studies exclude individuals with baseline depression or anxiety—conditions highly prevalent among older adults seeking cognitive evaluation, with cognitive impairment prevalence in depression ranging from 25% to 50% (Morimoto et al., 2020). Learning one has elevated amyloid without cognitive symptoms can induce existential distress and anticipatory grief that standard measures may not capture. Direct-to-consumer testing options lack the psychological support infrastructure of research protocols (Knopman & Bhatt, 2024). The context of result delivery matters profoundly: a patient might first learn of a positive biomarker result through a healthcare portal notification while driving on the highway, sitting alone at home, or in the middle of a busy work meeting with no human present to help them understand the meaning of the results or make a rapid plan for putting them into context.
The situation is further complicated by significant gaps in primary care provider training, the very providers who are most frequently asked to evaluate cognitive complaints and order AD biomarker tests (Palmqvist et al., 2024). According to the Alzheimer’s Association 2020 Facts and Figures report, half of primary care physicians say the medical profession is not prepared to meet expected increases in dementia demands, and 78% agree that medical school and residency can never adequately prepare a physician for the realities of Alzheimer’s and dementia care. Nearly 40% report they are “never” or only “sometimes” comfortable making a dementia diagnosis. Research confirms these concerns: only 21% of primary care providers report high confidence in recognizing neurocognitive disorders, and just 13% feel confident making a specific dementia diagnosis (Bernstein Sideman et al., 2019). Into this landscape of undertrained providers comes aggressive marketing suggesting that a simple blood test can provide diagnostic clarity—a dangerous combination.
A Test for Whom? Equity and Access
Access remains stratified by socioeconomic status, geography, and insurance coverage. Most validation studies enrolled predominantly White, educated participants. Three of four experimental blood tests perform differently in Black versus White individuals (Schindler et al., 2024), potentially risking misdiagnosis. Meanwhile, Black Americans experience 35% lower odds of receiving an Alzheimer’s diagnosis despite higher population-level prevalence (Lennon et al., 2022). Accessible blood-based testing will ring hollow if it perpetuates existing disparities.
The enthusiasm for biomarker testing threatens to marginalize comprehensive clinical assessment. Neuropsychological evaluation remains critical for accurate diagnosis, characterizing clinical profiles, and developing individualized recommendations (Shaughnessy et al., 2025). The Alzheimer’s Association guidelines affirm that biomarkers do not substitute for comprehensive evaluation (Palmqvist et al., 2025). Yet in resource-constrained settings, simple blood tests may displace nuanced functional assessment. Biomarkers cannot capture daily functioning, emotional wellbeing, or values regarding intervention.
Current consent practices frequently fail to prepare patients for results’ uncertainty and emotional impact. Researchers have proposed detailed disclosure processes including appropriateness assessment, pretest education, meaningful consent, and structured follow-up (Largent et al., 2023). Pretest consent does not release clinicians from responsibility for post-disclosure outcomes (Grill et al., 2021). The gap between ideal and actual consent processes represents a significant ethical vulnerability that demands attention from our profession.
Toward an Integrated Diagnostic Standard
Biomarker testing represents a genuinely important advance in our understanding of Alzheimer’s disease pathology but it is one piece of a diagnostic puzzle, not the puzzle itself. The newly published Alzheimer’s Association DETeCD-ADRD clinical practice guidelines reinforce this point explicitly, proposing a structured evaluation framework in which biomarker testing follows and never replaces comprehensive clinical evaluation (Dickerson et al., 2025; Atri et al., 2025). Responsible clinical integration of these tools requires a framework that honors both their promise and their limitations.
First, biomarker results should never be delivered in a vacuum. Whether communicated through a portal notification, a brief phone call, or an unprepared primary care visit, results without context are results without meaning and potentially without safety. Preparing primary care providers to appropriately order and disclose blood-based biomarker results is among the most pressing implementation challenges the field currently faces (Erickson et al., 2025). Disclosure in a primary care setting requires particular care, as patients vary widely in health literacy, emotional readiness, and access to follow-up support (Bolton et al., 2025). Trained medical providers must communicate findings with explicit caveats: that a positive biomarker indicates biological risk, not clinical diagnosis; that a meaningful percentage of individuals with amyloid burden never develop dementia (Stern, 2012); and that results exist along a probabilistic continuum rather than as a binary verdict. Detailed disclosure processes including appropriateness assessment, pretest education, meaningful consent, and structured follow-up represent the standard of care, not an optional add-on (Largent et al., 2023). Patients deserve time, a knowledgeable guide, and a clear next step.
Second, biomarker findings should be situated within comprehensive neuropsychological testing conducted by a clinician with specialized expertise in the cognitive, behavioral, and functional aspects of the dementias. Neuropsychological evaluation adds what no blood test can provide: a detailed characterization of the individual’s current cognitive profile, functional independence, emotional status, and the degree to which biological changes have—or have not—translated into meaningful clinical impairment (Shaughnessy et al., 2025). Comprehensive neuropsychological assessment offers superior accuracy in distinguishing mild cognitive impairment from early dementia, contributes incremental predictive value beyond biomarker status alone, and provides essential information about longitudinal changes in daily functioning (Alzola et al., 2024; Kwak, 2025). It cannot responsibly be displaced by biomarker results alone.
Third, a thorough diagnostic interview with a provider who holds expertise in the cognitive, behavioral, and functional components of the dementias is essential for integrating all available information into a coherent, individualized clinical picture. Such an interview captures what standardized tests cannot: the patient’s own narrative, informant observations, functional trajectory, and values regarding intervention. The DETeCD-ADRD guidelines specifically call for a person-centered evaluation that empowers providers to approach the diagnostic and disclosure process as a patient–caregiver dyad, not a transaction (Dickerson et al., 2025; Atri et al., 2025).
Our Obligation to Act
As part of our commitment to advocacy, ABPP psychologists must become active voices in public education about dementia diagnosis. The misinformation gap created by aggressive marketing cannot be filled by clinical encounters alone. I urge colleagues to harness the power of social media platforms and local community talks to expound on the evidence-based value of neuropsychological evaluation. Our expertise positions us uniquely to explain that neuropsychological measures demonstrate very good to excellent predictive accuracy for identifying individuals who will progress to dementia (Belleville et al., 2017).
As stewards of diagnostic integrity, ABPP psychologists are increasingly called upon to interpret, explain, and mitigate the consequences of biomarker testing, a role explicitly recognized within the emerging framework of dementia diagnostic guidelines (Shaughnessy et al., 2025; Dickerson et al., 2025). The biological revolution offers genuine hope for earlier intervention. Realizing that hope without causing harm requires wisdom to recognize what biomarkers can and cannot tell us, humility to acknowledge uncertainty, and commitment to keep the person at the center of care.
We can help the public understand that comprehensive cognitive assessment remains essential for accurate diagnosis, care planning, and determining intervention appropriateness (Atri et al., 2025; Shaughnessy et al., 2025). The DETeCD-ADRD guidelines are explicit on this point: the goal of evaluation is to characterize the patient’s cognitive and functional status and underlying brain disease in order to develop optimal care plans that maximize quality of life for both the patient and care partner, a goal no blood test alone can achieve (Atri et al., 2025). Every community presentation, every social media post, every media interview represents an opportunity to counter the narrative that a simple blood test provides definitive answers to the complex syndromes of dementia (Bolton et al., 2025; Hansson et al., 2024). We can also consider briefer assessment or counseling protocols to accompany biomarker test results as part of our typical clinical schedule.
Board-certified clinicians who engage thoughtfully with this evolving landscape both in clinical settings and in public spaces can help ensure scientific progress serves human flourishing rather than reducing individuals to molecular signatures. The path forward is not a choice between biological innovation and clinical wisdom. It is their integration (Dickerson et al., 2025; Palmqvist et al., 2025).
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Karen Sullivan, PhD, ABPP
Board Certified in Clinical Neuropsychology
Correspondence: DrSullivan@PinehurstMemory.com