Biomarker Advances and Challenges in Early Alzheimer Disease Detection: Sylvia Villeneuve, PhD

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"I think that moving forward in the clinic, it’s probably going to be possible to do a panel of markers and then identify patients who are at high risk of having AD, the ones that we should really try to intervene with but it's like which patients to watch out for and then the ones that would be in the ‘OK’ zone.”

Preclinical Alzheimer disease (AD) refers to the stage when underlying disease processes occur in the brain such as amyloid plaque and tau tangle accumulation, before measurable cognitive symptoms appear. Increasing evidence has shown that this phase of AD can begin years, even decades, before a clinical diagnosis is made, possibly creating a critical window for early detection and preventive intervention. Recent advancements in biomarker technology are making it more possible to identify patients who are at risk during this silent stage of AD, offering the potential to slow or delay disease progression before symptoms emerge.

Recently, at the 2025 Alzheimer’s Association International Conference, held July 27-30, in Toronto, Canada, Sylvia Villeneuve, PhD, an associate professor in the Department of Psychiatry at McGill University, presented on biomarker and clinical trajectories of preclinical AD in a plenary session.¹ During the presentation, she highlighted that positron emission tomography (PET) imaging remains the most specific tool for detecting amyloid plaques and tau tangles in the brain; however, its high cost and specialized equipment requirements limit widespread clinical use. In contrast, blood-based biomarkers, although less specific and detecting soluble protein forms, may be more accessible and can predict risk up to 10 years before cognitive decline.

In a follow-up interview NeurologyLive^®, Villeneuve emphasized that the future of early AD detection may lie in panels combining multiple biomarkers, including amyloid, tau, neurodegeneration, and inflammation measures, to improve accuracy and risk stratification. She also underscored the influence of individual risk factors such as APOE4 status, sex, and menopause-related metabolic and vascular changes on disease onset. Understanding these modifiers, she noted, could be essential for tailoring prevention strategies and identifying the individuals most likely to benefit from early intervention.

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REFERENCES
1. Villeneuve S. Biomarker and Clinical Trajectories of Preclinical AD. Presented at: 2025 Alzheimer’s Association International Conference; July 27-31; Toronto, Canada. Plenary session.