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Disease surveillance is the systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice. This process integrates data dissemination to entities responsible for preventing and controlling disease, injury, and disability. Surveillance systems provide crucial information for action, helping public health authorities make informed decisions to manage and prevent outbreaks, ensure public safety, optimize...
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Public Health.

Zachary Sheff1, Nalin Payakachat1, E Jolanda Muenzel1

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|December 23, 2025
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Summary
This summary is machine-generated.

Millions of older adults have preclinical Alzheimer's disease (AD), identified by biomarker evidence. Blood-based biomarkers like plasma p-tau217 can identify those at highest risk for cognitive decline, aiding future treatment strategies.

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Area of Science:

  • Neurology and Gerontology
  • Biomarker Discovery
  • Epidemiology

Background:

  • Preclinical Alzheimer's disease (AD) is characterized by biomarker evidence of AD pathology in cognitively unimpaired individuals.
  • Current diagnostic methods (PET scans, CSF collection) are invasive and not standard for cognitively unimpaired populations.
  • Blood-based biomarkers (BBMs) offer a minimally invasive, scalable, and cost-effective alternative for AD detection.

Purpose of the Study:

  • To estimate the number of individuals aged 50+ with preclinical AD at greatest risk for cognitive decline in the US, Japan, Germany, and China.
  • To assess the potential utility of plasma p-tau217 levels in identifying high-risk preclinical AD populations.
  • To inform healthcare infrastructure and budget planning for future AD interventions.

Main Methods:

  • Utilized country-specific census data and literature-based prevalence estimates for dementia, MCI, and amyloid PET positivity.
  • Applied recent findings linking top-tertile plasma p-tau217 levels to the highest rate of clinical progression in amyloid-positive, cognitively unimpaired individuals.
  • Estimated the high-risk preclinical AD population by considering one-third of the amyloid PET-positive preclinical AD population.

Main Results:

  • Estimated preclinical AD populations (50+) based on amyloid PET positivity: US (22.0M, 18.3%), Japan (11.2M, 19.0%), Germany (7.0M, 18.5%), and China (90.7M, 17.0%).
  • Estimated high-risk preclinical AD populations (top tertile p-tau217): US (7.3M, 6.1%), Japan (3.7M, 6.3%), Germany (2.3M, 6.2%), and China (30.2M, 5.7%).

Conclusions:

  • The significant number of individuals with preclinical AD highlights the need for efficient screening methods.
  • Blood-based biomarkers like plasma p-tau217 can help identify high-risk individuals, potentially reducing healthcare burdens.
  • Further research on plasma p-tau217 prevalence in preclinical AD is crucial for economic impact assessments and treatment planning.