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Cut‐points and gray zones: The challenges of integrating Alzheimer's disease plasma biomarkers into clinical practice

Hazan, J; Liu, KY; Isaacs, JD; Howard, R (2025) Cut‐points and gray zones: The challenges of integrating Alzheimer's disease plasma biomarkers into clinical practice. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 21 (3). e70113. ISSN 1552-5260 https://doi.org/10.1002/alz.70113
SGUL Authors: Isaacs, Jeremy

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Abstract

Plasma biomarkers for Alzheimer's disease (AD), such as plasma phosphorylated (p)‐tau217, offer a more accessible means of testing for the presence of AD pathology compared to cerebrospinal fluid (CSF) or positron emission tomography (PET) methods. They can support diagnostic assessment and determine patient eligibility for treatment with amyloid beta–lowering drugs in community settings where access to CSF examination and amyloid‐PET are limited. However, there are important challenges associated with interpreting and integrating plasma biomarker results in clinical practice. This article explores different approaches to interpreting plasma biomarker results in secondary care, important potential sources of uncertainty, and considerations for their clinical application. Highlights Plasma biomarkers such as phosphorylated tau‐217 (p‐tau217) offer a promising, accessible alternative to cerebrospinal fluid (CSF) and positron emission tomography (PET) for detecting Alzheimer's disease pathology, especially in settings with limited diagnostic resources. Clinical integration of plasma biomarker testing presents challenges, particularly in interpreting results. This includes uncertainties around intermediate results and their role in patient management. Clear frameworks and guidelines are essential to optimize the use of plasma biomarkers, supported by further research and education to ensure effective application in clinical practice.

Item Type: Article
Additional Information: © 2025 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
SGUL Research Institute / Research Centre: Academic Structure > Neuroscience & Cell Biology Research Institute
Academic Structure > Neuroscience & Cell Biology Research Institute > Neurological Disorders & Imaging
Journal or Publication Title: Alzheimer's & Dementia: The Journal of the Alzheimer's Association
ISSN: 1552-5260
Language: en
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
CRTF2023B-003Alzheimer’s Research UKhttps://doi.org/10.13039/501100002283
UNSPECIFIEDUniversity College London Hospitals’ National Institute for Health Research (NIHR) Biomedical Research CentreUNSPECIFIED
MR/S021418/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
URI: https://openaccess.sgul.ac.uk/id/eprint/117473
Publisher's version: https://doi.org/10.1002/alz.70113

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