World Dementia Council Update: Biomarker Implementation

How to implement Alzheimer's biomarker testing into healthcare systems.

Guest Author

07 Aug 2026 — 6 min read

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Alzheimer's disease (AD) biomarkers have the potential to completely transform how patients are diagnosed and ongoing research promises even more advances in earlier diagnostics and risk awareness. However, without health system readiness and a clear path to widespread implementation, these advancements will not reach those who need them most. To better understand these developments and the implications for policy, advocacy, and health-care systems, the World Dementia Council (WDC) in partnership with the Alzheimer's Society, convened experts across research and practice for a virtual dialogue on April 9, 2026. Chaired by Dr. Fiona Carragher, Chief Policy and Research Officer at the Alzheimer's Society, this discussion addressed many of the questions related to the promise of biomarkers and challenges surrounding implementation.

(1) INTRODUCTION

Lenny Shallcross, executive director of the WDC, introduced the dialogue and the key theme of the session: how can we move from innovation to health system implementation? Dr. Carragher built upon this question, noting that innovation alone will not change patient outcomes, it must be coupled with implementation for real patient impact. The challenge is no longer whether these biomarkers work, but whether they can be meaningfully integrated into care pathways. Simply adding biomarkers into existing systems will not be sufficient; instead, we must determine the optimal place for biomarkers within a redesigned system to improve patient outcomes. Experiences from other conditions like cancer and COVID show how quickly health systems can evolve when necessary. These lessons can be used as valuable models in transforming dementia care and diagnosis.

(2) EXPANDING ACCESS, ACCELERATING IMPACT

Dr. Jeffrey Burns, professor and co-director at the University of Kansas Alzheimer's Disease Research Center, reiterated the importance of health system change to ensure optimal results. To help drive this change and improve access and impact, Dr. Burns and his team are building a new approach to brain health-care delivery, centered on primary care. Tools have been embedded within the primary care provider (PCP) electronic health record, including clinical interview guides and referral pathways, to support decision making and the post-diagnostic process.

The model also focuses on supporting primary care to more effectively leverage blood-based biomarkers. Through education and broad system support, PCPs were equipped with information and training to use tools like biomarkers more effectively. As a result of this supportive environment, there has been rapid and broad uptake of biomarker use across the system, with 188 clinicians, including a significant proportion of PCPs, using these tools appropriately. Memory clinics are also being transformed through this model. Rather than a one-size-fits-all approach, they are being sectioned into subclinics focused on different areas including complex diagnosis, memory care e-consults, anti-amyloid treatment, comprehensive support, and prevention and monitoring.

At the system level, this approach is being supported through advocacy efforts at the state legislature and a vision for a statewide hub-and-spoke to expand access across Kansas. This model would seamlessly integrate biomarkers, telehealth escalation, and artificial intelligence (AI)–enabled intake to improve efficiency and to ensure consistency, scalability, and improved patient outcomes.

(3) UK'S PATH TO BIOMARKER IMPLEMENTATION

Dr. Vanessa Raymont, associate professor at the University of Oxford and R&D director at the Oxford Health NHS Foundation Trust, shared that while biomarkers represent a major scientific breakthrough, integrating them into health systems can be seen as a daunting challenge. This is especially true in publicly funded health systems, such as in the UK, which often move slowly despite strong infrastructure. However, progress has been made to help facilitate this implementation: guidelines for biomarker use are in place, disease-modifying treatments are emerging, and understanding of risk has advanced significantly.

Patient and public perceptions and expectations around dementia and biomarkers are shifting rapidly, making health system change even more urgent. A key barrier to implementation is health economics, and there is an urgent need to demonstrate the value of biomarkers within existing systems. As more individuals present with knowledge of their biomarker status, health systems will need to adapt quickly.

Dr. Raymont also detailed the potential of biomarkers to transform diagnostic and care pathways, particularly through improved triage and earlier intervention. However, critical questions remain around when and how to use them, whether in symptomatic patients, at-risk populations, or even at a population level, especially given that most health systems are not equipped to manage this risk. Challenges around cost effectiveness, regulatory approval, and validation are also present, alongside opportunities to integrate AI to enhance patient identification and stratification.

(4) CLINICAL CONSEQUENCES OF BIOMARKER INTEGRATION

Dr. Argonde van Harten, clinical lead and senior researcher at the Alzheimer Center Amsterdam, provided her team's experience of implementing biomarkers within the health system in the Netherlands. She shared that while accessible and accurate diagnostics are important, demonstrating clear clinical benefit will be essential for broad adoption.

Through the CANTATE project, Dr. van Harten and team developed a decision model to guide how providers use biomarkers and evaluated the results across multiple memory clinics. Initial findings showed modest clinical impact, with a significant proportion of results falling into an intermediate range, signifying less added value. However, a second iteration, which incorporated phosphorylated tau 217, improved results by reducing uncertainty and increasing clinical usefulness. Overall, biomarkers led to meaningful clinical impact in approximately 20% of patients, including changes in diagnosis, diagnostic confidence, and downstream care decisions and referrals. Clinicians also leveraged the biomarkers in a logical and responsive manner and in alignment with initial clinical assessments.

Dr. van Harten concluded by highlighting key considerations for biomarker implementation. Ongoing clinician education will be critical to ensure accurate interpretation of results within the context of each individual patient. Finally, she noted that in the Netherlands, meaningful change will not occur without updates to clinical guidelines. Strong scientific evidence and continued collaboration with researchers around the work will be necessary to inform these guidelines and make further progress on implementation.

(5) LESSONS FROM OTHER DISEASE STATES

Dr. Mark McClellan, professor of practice at Duke University, highlighted lessons from cardio-kidney metabolic disease as a model for scaling new, upstream models of care to manage risk. While acknowledging the differences between the United States and other health systems around the world, he noted that all systems face similar challenges including capacity constraints and funding challenges that make large-scale changes difficult, even when treatments and diagnostics are available.

Reflecting on the other disease states, Dr. McClellan emphasized that population impact cannot fully rely on specialist care, it must be integrated into prevention-focused primary care to make a difference. Biomarkers can play a key role here in identifying at-risk individuals, guiding care, and health monitoring, alongside lifestyle interventions and risk-reduction strategies. Experience from cardio-kidney metabolic care also shows the value of longitudinal, team-based models supported by digital and AI-enabled tools.

US models, including Medicare pilots and programs like Advancing Chronic Care with Effective, Scalable Solutions (ACCESS), demonstrate how coordinated, person-centered care can be delivered at scale through use of digital tools. Similar approaches could be applied to AD, particularly in earlier stages when risk management is key. However, achieving this will require stronger primary care systems, integrated care pathways, and more evidence on how to deliver these models at scale.

(6) DISCUSSION

After the speaker presentation, participants engaged in discussion about the challenges and opportunities the field faces in efficiently leveraging biomarkers within health systems. A central discussion point was the critical role of primary care, alongside ongoing questions about clinician education and how to ensure appropriate and consistent use of biomarkers in practice. Ongoing and detailed education will be essential to support biomarker implementation and build provider confidence.

Participants also discussed key considerations around the use of biomarkers in preclinical populations, including ethical implications and access to care concerns. Although it is likely that biomarkers are moving in this direction, many significant questions remain about the use of these tests in individuals with and without symptoms. At the same time, increasing availability of direct-to-consumer testing means more individuals will present with biomarker information, forcing health systems to adapt quickly.

The discussion emphasized the importance of advocacy organizations in shaping this evolving landscape, as well as the difficulty of implementing large-scale system change. However, examples from other regions and disease areas offer practical pathways forward. In Canada, primary care–led memory clinic models have been successfully expanded, while participants noted that approaches like those described by Dr. Burns closely mirror established chronic disease management systems.

Overall, there was strong alignment across participants on the direction of biomarker use and recognition that continued cross-country learning and insights from other disease areas will be essential to advancing implementation.

To learn more about the WDC, please visit worlddementiacouncil.org or email Lenny Shallcross, executive director, at lenny.shallcross@worlddementiacouncil.com.