Biomarker-Driven Diagnosis in Neurocognitive Disorders: A Clinician's Perspective on the Risks of Reductionism

The recently published Alzheimer's Association Workgroup diagnostic criteria for Alzheimer disease and consensus-based workflows for the use of diagnostic biomarkers in neurocognitive disorders promote further normalization of purely biological approaches to neurocognitive disorders. In this commentary, we reflect on the dangers of biological reductionist positions lacking solid scientific evidence and proven cost-effectiveness benefits, in particular its inability to offer a meaningful formulation for the large number of people with functional cognitive disorders. This, alongside the current lack of standardization, limited accuracy, and environmental consequences, means that the normalization of biomarkers as standard-of-care tests in all neurocognitive presentations does not represent responsible innovation. We emphasize the need for pluralism when considering technological developments, such that clinical judgment and biopsychosocial formulation continue to be accepted as a sound foundation for cognitive assessment.