New Alzheimer’s disease diagnostics and psychological clinical perspectives

Abstract

Recent advances in blood-based biomarkers have transformed the early diagnosis of Alzheimer’s disease (AD), enabling the identification of biological risk at preclinical and presymptomatic stages in a noninvasive and accessible manner. Despite this diagnostic progress, the expansion of psychological clinical services in dementia care has not kept pace, representing a critical gap in the current management of AD. This theoretical paper critically discusses the role of psychological clinical practice in the prevention and management of AD in light of these diagnostic advances, particularly from the perspective of the International Working Group (IWG), which defines AD as a clinical-biological entity and recommends that cognitively normal individuals with positive biomarkers be considered at risk rather than diagnosed. Based on this framework and on evidence from the 2024 Lancet Commission on dementia prevention, we propose a three-phase roadmap for the integration of psychological care into multidisciplinary AD management. Phase 1 encompasses universal prevention through psychoeducation, cognitive reserve promotion, and emotional education. Phase 2 targets at-risk individuals with elevated biomarker profiles, focusing on neuropsychological evaluation, risk disclosure support, and early cognitive intervention. Phase 3 addresses individuals with established AD through cognitive rehabilitation and caregiver support. We further argue that government policies must integrate psychologists into multidisciplinary neurological and geriatric teams, and that psychology training programs must be updated to prepare professionals for preventive roles. More research on standardized psychological protocols for pre-dementia contexts is urgently needed.