“Pathology-targeting treatments, blood biomarkers and digital tools are transforming Alzheimer’s care.”
Prof. Michael Schöll is Professor of Molecular Medicine at the University of Gothenburg, Sweden, and Principal Research Fellow at University College London (UCL), based at the renowned Queen Square Institute of Neurology. His research focuses on molecular imaging, fluid biomarkers, and early diagnostics for neurodegenerative diseases, particularly Alzheimer’s disease. In this interview at EAN 2025, Prof. Schöll discusses the evolving role of plasma biomarkers in Alzheimer’s diagnosis and treatment, the challenges of clinical implementation, and the innovations he believes will transform care pathways.
1. How have plasma biomarkers changed the approach to early and pre‑clinical Alzheimer’s disease diagnosis compared to traditional CSF or PET testing?
When it comes to very early, especially preclinical, stages of Alzheimer’s, plasma biomarkers haven’t yet changed diagnostic routines. They certainly have the potential to do so, and that’s what we’re researching right now. We’re running a large population-based study called Real AD, which is one of many international efforts aiming to validate the diagnostic and prognostic potential of blood-based biomarkers in people who have brain amyloidosis but no symptoms yet. This is a critical group for considering early initiation of disease-modifying treatments. At this stage, though, I think it’s still premature to implement plasma biomarkers for diagnosis or screening in clinical settings. We need more data before making that step.
2. In patients with mild cognitive impairment (MCI) or atypical presentations, how are plasma biomarkers shaping diagnostic pathways?
We’re still in very early days for the clinical use of plasma biomarkers. Only a few places worldwide are currently using them in routine diagnostic workups, but this is growing rapid, likely month by month. For people with MCI, plasma biomarkers are clearly a use case. I believe they will become a mainstay of diagnostic pathways, particularly markers like p-tau217 or variants that use ratios, for example, p-tau217 to Aβ42/40, or phosphorylated to non-phosphorylated tau.
In atypical Alzheimer’s presentations, plasma biomarkers are very useful for ruling out Alzheimer’s disease. However, they do not replace tau PET imaging, which remains the gold standard for subtyping Alzheimer’s pathology. Plasma p-tau reflects soluble tau pathology and also correlates with amyloid status, but it doesn’t directly capture the same information as tau PET, which visualizes aggregated tau. At this point, there’s no strong evidence that plasma biomarkers alone can predict specific atypical presentations in the same way that tau PET can.
3. What challenges are clinicians encountering when adopting plasma biomarker assays?
The main challenge is the lack of clear guidelines for interpreting these biomarkers, especially for general practitioners. We are getting very close to filling that gap thanks to ongoing research. A major obstacle is how clinicians should interpret results and how this ties into treatment decisions. This will evolve in parallel with how disease-modifying therapies (DMTs) are approved and integrated into health systems.
There is also a mindset barrier, there is some scepticism remaining about why we should diagnose Alzheimer’s earlier or more robustly than we currently do. But as the treatment landscape develops, this mindset is shifting. Earlier and more accurate diagnosis will become increasingly important.
4. How are plasma biomarkers influencing treatment planning and eligibility for disease-modifying therapies?
Right now, to the best of my knowledge, plasma biomarkers are not yet influencing treatment decisions directly. They are not replacing CSF or PET for confirming diagnoses in clinical practice. In some specialist settings, like memory clinics, biomarkers such as p-tau217 may help support decisions around existing symptomatic treatments. It’s possible that in some places, plasma biomarkers are beginning to support decisions around DMT eligibility, but it’s not widely adopted yet.
In clinical trials, p-tau217 is being used, but it’s not yet a monitoring marker in the same way as amyloid PET. The change in plasma p-tau217 levels after treatment with monoclonal antibodies, for example, is much smaller than the reduction seen in amyloid PET scans. We don’t yet know whether this is because plasma p-tau is a more indirect measure of brain amyloid or whether peripheral factors influence levels. Right now, that limits its use as a standalone monitoring tool.
5. What current innovations in Alzheimer’s disease excite you the most?
It’s a broad question, but I’d say three things stand out.
- The emergence of pathology-targeting treatments is a major breakthrough, it’s something we’ve hoped for since I joined this field.
- The progress in blood-based biomarkers has exceeded expectations.
- I’m very excited about digital biomarkers, for example, being able to monitor cognition and symptoms at home to complement the diagnostic process.
Together, these developments have the potential to transform not only clinical practice but also how healthcare systems, decision-makers, and even patients and caregivers think about Alzheimer’s.
Interviewer: Caroline Markham, Head of Partnerships.
Editor: Katey Gabrysch, Editorial Director.
Disclosures: Grant/Research Support from Beckman Coulter, Bioarctic, Roche, and Eli Lilly; on the advisory board for Eli Lilly, Novo Nordisk, and Roche, and has received honoraria/honorarium from Bioarctic, Eli Lilly, Novo Nordisk, and Roche; and is a major stock shareholder in Centile Bioscience.
No funding was received in the publication of this article. This content has been developed independently by Touch Medical Media for touchNEUROLOGY. Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Cite: A new era in early Alzheimer’s diagnosis? The power of plasma biomarkers. touchNEUROLOGY. 23 June 2025.
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