The message from the global roundtable organized by the World Dementia Council and the Alzheimer’s Society – biomarkers alone will not fix dementia care.
The Biomarker Translation: From Innovation to Implementation roundtable – of which I was a part – at the beginning of April included leaders in dementia research, clinical care, diagnostics, health policy and patient advocacy. We focused on one key question: now that blood-based tests for Alzheimer’s disease are becoming available, how can they be used to improve care for patients and families?
But without changes to how health systems are designed, staffed and funded, even the best new tests can add confusion instead of improvement. For those working in publicly funded systems – such as in Canada, the United Kingdom and Europe – this was a sobering but useful reality check.
Canada’s experience with the blood test p-tau217 illustrates the gap between new technology and real‑world use. The test is available through LifeLabs and Dynacare, but it cannot be ordered directly by patients. It must be requested by a clinician, such as a family doctor, neurologist, geriatrician or memory clinic. Coverage varies by province and care setting. Public health plans like OHIP in Ontario or MSP in British Columbia do not pay for it in most cases. As a result, the test often is paid for out of pocket or accessed only through special programs such as memory clinics.
In clinical care, p‑tau217 is not used on its own. It helps doctors tell Alzheimer’s disease apart from other types of dementia, estimate the chance that amyloid is present in the brain, reduce unnecessary PET scans or spinal taps and support decisions about new anti‑amyloid treatments. The results must always be considered alongside a person’s symptoms, cognitive tests and – when needed – brain scans or spinal fluid tests.
Tests like p‑tau217 can reliably reflect changes in the brain linked to Alzheimer’s disease. At the same time, new treatments that may slow disease progression are becoming available, making early and accurate diagnosis more important than ever. But as many speakers stressed, new tools alone do not improve outcomes. How they are used matters just as much.
In the U.K., it still takes an average of three-and-a-half years for someone to be diagnosed with dementia, and only about two‑thirds of people ever receive a diagnosis. Canada faces similar problems, including long wait times, fragmented care and not enough specialists. Adding tests into these systems without changing how care is delivered risks increasing costs without improving patient experience
Blood‑based biomarkers should be seen as tools that force systems to change. They raise difficult but important questions: Who should diagnose dementia? Should testing happen in primary care or specialist clinics? What support is offered after diagnosis? And how do we ensure fair access and proper follow‑up in a stretched health system?
One strong example came from Jeff Burns at the University of Kansas Alzheimer’s Disease Research Centre. His team was up against challenges including long distances, limited specialist access and major delays in diagnosis. Instead of increasing specialist clinics, the team redesigned the care pathway around primary care.
In Kansas, family doctors are now the main starting point for dementia diagnosis. They receive support through electronic medical record tools, short online training and quick access to blood‑based tests. Specialist memory clinics still exist, but they now focus on complex cases, new treatments, long‑term support and monitoring. Many referrals happen through electronic consultations rather than automatic in‑person visits.
The results are impressive. In one year, more than 2,500 biomarker tests were ordered by 188 clinicians, more than half of them in primary care. Early reviews show the tests were used appropriately in most cases. This approach also increased specialist clinic capacity by about 50 per cent, without hiring more staff, simply by matching patients to the right level of care.
Examples from the United States, Canada and Europe show that strong local leadership, hub‑and‑spoke care models and well‑organized memory clinics in primary care can reduce long wait times for specialists. These approaches make it easier for people to get care while keeping the quality high.
In Ontario and other parts of Canada, these examples are especially important. They support the idea that dementia should be treated like other long‑term illnesses, such as diabetes or heart disease. In these models, primary care leads ongoing care, and specialists provide help when needed.
Vanessa Raymont from the University of Oxford noted that in publicly funded systems, change is slow, evidence standards are high and budgets are tight. Dementia care pathways have changed very little over decades, even though science has advanced rapidly.
Raymont explained that biomarkers could improve diagnosis, referral decisions and use of resources – but only if systems are ready to support people at different levels of risk. Many people with abnormal test results may not yet qualify for treatment, but they still need monitoring, counselling and follow‑up.
Her observational study is examining how people respond to learning their biomarker results in real‑world settings, especially in populations that are often under-represented. The study shows that implementation is not just a technical issue, it is also social and ethical – how results are explained, what people want to know, and how systems respond all matter.
Argonde van Harten and his team from the Alzheimer Centre Amsterdam have shown that early use of blood‑based tests led to many unclear results that did not help decision‑making. However, after improving test combinations and decision rules, confidence in diagnosis increased and care plans changed for about 20 per cent of patients.
The lesson is clear: biomarkers do not automatically improve care. Their value depends on accuracy, clinician training, and the setting in which they are used. In both the Netherlands and Canada, wider adoption will depend on updated clinical guidelines and strong professional agreement.
Mark McClellan, a former leader of the U.S. Food and Drug Administration and Medicare, placed dementia in a broader health system context. He pointed to prevention‑focused, primary care‑based models used for cardio‑renal‑metabolic disease. This term refers to linked conditions like heart disease, kidney disease, diabetes, obesity and high blood pressure, which often occur together and make each other worse.
In these models, early testing helps identify people at higher risk, guide treatment and track progress over time. Success depends on team‑based care, digital tools and payment systems that reward better outcomes, not just more visits. Dementia care could follow a similar path.
Many speakers at the roundtable warned against using blood‑based tests for population screening too soon. Past mistakes in cancer screening show how tests can lead to over‑diagnosis and harm when used incorrectly. While biomarkers are powerful, they are not perfect predictors for individuals. Ethical, legal and insurance concerns must be addressed carefully.
The shared view was clear: biomarkers should first be used for people with symptoms to support – not replace – clinical judgment.
This global discussion reinforced several lessons for Canada. Dementia reform is mainly about system design, not technology alone. Primary care‑led models are essential given workforce shortages. Strong local leadership makes a real difference.
Blood‑based biomarkers offer a real opportunity to improve dementia care – but only if we redesign our systems to use them wisely. The real question is no longer whether we can introduce these tests, but whether we are willing to change how care is organized so they truly make a difference.
