Insights & Implications in Brain Health
What the latest science means for your patients today
Volume 1, 2026 | Primary Care Edition
IN THIS ISSUE
01 Blood-based bioomarkers: new AA guideline on when and how to use them
02 Digital cognitive assessment: 95% of PCPs want to adopt — barriers remain operational
03 Anti-amyloid therapies: real-world persistence data and what's next
04 Care planning in ADRD: ACP reduces costs and hospitalizations
05 Modifiable risk factors: 45% of dementia may be preventable
06 Caregiver support: structured interventions reduce burden and isolation
01 BLOOD-BASED BIOMARKERS
New Alzheimer's Association guideline defines when blood-based biomarkers are ready for specialist use — and what it means for primary care next
INSIGHTS
The Alzheimer's Association released its first clinical practice guideline for the use of blood-based biomarkers (BBMs) in diagnosing suspected Alzheimer's disease, focused initially on specialized care settings. The guideline recommends that BBM tests achieving at least 90% sensitivity and specificity can substitute for PET amyloid imaging or CSF testing in specialist-evaluated patients with cognitive impairment.
The panel identified four reasons why primary care warrants its own separate guideline process: differing prevalence of AD pathology, different pre-test probability, limited non-specialist experience interpreting and disclosing BBM results, and higher rates of comorbidities that can affect BBM accuracy.
The guideline also cautions that significant variability exists across commercially available BBM tests, and many do not currently meet the recommended accuracy thresholds.
"BBM tests with ≥90% for both sensitivity and specificity can serve as a substitute for PET amyloid imaging or CSF testing."
IMPLICATIONS FOR PRIMARY CARE
This guideline makes clear that BBMs are coming to primary care — but the infrastructure must come first. PCPs will need structured, objective cognitive data and clear pre-test probability to order BBMs appropriately and interpret results with confidence. Without this foundation, results risk being misleading, particularly in practices with high rates of comorbidities like diabetes, hypertension, and depression.
The forthcoming primary care-specific BBM guideline will define the clinical sequence more precisely. Until then, the most impactful step PCPs can take is to systematize cognitive screening so that patients arrive at the BBM decision point with objective cognitive data already in hand.
02 DIGITAL COGNITIVE ASSESSMENT
GSA report: 95% of primary care providers want digital cognitive assessments — workflow and billing clarity remain the only barriers
INSIGHTS
A March 2026 report from the Gerontological Society of America (GSA) summarized survey findings on the readiness of the primary care workforce to adopt digital cognitive assessments (DCAs). Despite more than 95% of surveyed clinicians expressing strong interest in DCAs, the vast majority still rely on paper-based tools, which introduce subjectivity and may miss subtle early-stage changes in cognition.
Key priorities for adoption were EHR integration, clear coding and billing guidance, and provider training. When these enablers were present, DCAs were associated with improved early detection, diagnostic accuracy, and care coordination. The GSA noted that digital assessments provide granular cognitive trajectory data that paper tools cannot replicate.
"Digitizing assessments may improve care across the continuum by providing granular insights into cognitive trajectories."
— GSA Vice President Lisa C. McGuire, PhD
IMPLICATIONS FOR PRIMARY CARE
The clinical appetite for DCAs is overwhelming — the barriers are entirely operational. This report confirms that what is holding back adoption is not clinical skepticism but the absence of workflow-ready tools with clear reimbursement pathways. Practices that solve these integration challenges stand to gain in both diagnostic quality and revenue through AWV-linked reimbursable services.
The emphasis on EHR integration and billing clarity mirrors what primary care providers consistently report in practice: the tool itself is not the barrier — the workflow around it is. Solutions designed from the ground up for primary care environments, with mapped reimbursement, are what the market is waiting for.
03 ANTI-AMYLOID THERAPIES
Real-world lecanemab data: most patients continue therapy beyond 18 months — but identifying them early enough remains the challenge
INSIGHTS
Real-world data presented at AD/PD 2026 showed strong long-term treatment persistence with lecanemab in clinical practice. Of 10,763 patients analyzed via the PurpleLab CLEAR Claims database, 78.4% continued therapy at 18 months, 71.7% at 20 months, and 67.3% at 24 months — substantially better than persistence typically seen in other chronic disease therapies.
The FDA also accepted a Supplemental BLA in January 2026 for subcutaneous initiation dosing of lecanemab, granted Priority Review with a PDUFA date of May 2026. Subcutaneous formulation would substantially reduce the administrative burden of IV infusion, opening the door to broader primary care involvement in treatment pathways.
IMPLICATIONS FOR PRIMARY CARE
Anti-amyloid therapies are a sustained clinical reality, not a theoretical option. For PCPs, this creates a clear and growing role: identifying early-stage MCI patients who may be eligible before they progress beyond the treatment window. Patients who miss that window because they were never screened — or screened too late — lose the opportunity entirely.
If subcutaneous lecanemab gains approval in mid-2026 as expected, the pathway from PCP-based cognitive screening to treatment initiation will shorten significantly. Practices with structured screening workflows already in place will be best positioned to capture this population.
04 CARE PLANNING & POST-DIAGNOSIS SUPPORT
Advance care planning in ADRD reduces costs and shifts care away from hospitals — but most patients still have none
INSIGHTS
A 2026 national Medicare cohort study found that billed advance care planning (ACP) encounters in ADRD patients were associated with meaningfully lower total costs and a significant shift from inpatient to outpatient care. The effect was largest for patients with multiple ACP encounters, suggesting ACP is most valuable as an ongoing process rather than a one-time event.
Fewer hospitalizations in the ACP group likely reflected mechanisms specific to dementia: hospitalization frequently provokes delirium, agitation, and accelerated functional decline, while home- and outpatient-based crisis management better preserves daily routines and reduces caregiver strain. Despite this evidence, the vast majority of ADRD patients still have no documented care plan.
"Fewer crisis hospitalizations lessen emotional strain and logistical burden for caregivers, allowing earlier planning."
IMPLICATIONS FOR PRIMARY CARE
Structured, ongoing care planning in dementia patients is not administrative overhead — it is one of the highest-value clinical interventions available, reducing hospitalizations, ED visits, and total costs of care. This study provides strong economic evidence for a practice that clinicians have long recognized intuitively.
The 99483 Cognitive Assessment and Care Planning code exists precisely to support this, yet utilization remains low. This study's findings strengthen the clinical and financial case for fully utilizing this reimbursable service as a routine part of dementia management.
Riley C et al. Advance care planning in Medicare beneficiaries with Alzheimer's disease and related dementias. Alzheimer's & Dementia: Behavior & Socioeconomics of Aging. 2026. doi: 10.1002/bsa3.70070.
05 MODIFIABLE RISK FACTORS
Updated Lancet Commission: 45% of dementia cases are potentially preventable — and primary care holds most of the keys
INSIGHTS
The 2024 update to the Lancet Commission on Dementia Prevention identified 14 modifiable risk factors accounting for approximately 45% of dementia cases worldwide — up from 40% in 2020. Two new risk factors were added: untreated vision loss and elevated LDL cholesterol.
The full list spans the life course: hypertension, hearing loss, obesity, smoking, depression, physical inactivity, diabetes, excessive alcohol, air pollution, traumatic brain injury, social isolation, and limited education. Most are conditions routinely managed in primary care — often without explicit connection to cognitive risk. The Commission notes the greatest prevention impact occurs in midlife, but late-life factors including social isolation and vision loss are increasingly recognized as meaningful targets.
"Around 45% of dementia cases are potentially preventable by addressing 14 modifiable risk factors across the life course."
IMPLICATIONS FOR PRIMARY CARE
Nearly half of all dementia is theoretically preventable through conditions PCPs see every day. This reframes cognitive care not as a specialty-only domain but as a core part of primary care's preventive mandate. Blood pressure control, cholesterol management, hearing referrals, depression treatment, and exercise counseling are dementia prevention strategies — not just general health interventions.
The addition of LDL cholesterol is particularly actionable: already routinely measured and treated, the implication is that more aggressive LDL management in midlife may carry cognitive benefits beyond cardiovascular risk reduction.
06 CAREGIVER SUPPORT
New Alzheimer's Association guideline defines when blood-based biomarkers are ready for specialist use — and what it means for primary care next
INSIGHTS
A January 2026 study in Frontiers in Dementia evaluated an online peer support intervention for family caregivers of people living with dementia. Participants reported both emotional and practical benefits: reduced isolation, increased confidence, improved communication strategies, and better care skills. The study found that connecting with others who understand the caregiving experience is a distinct mechanism of benefit — not just informational content, but the emotional validation of shared experience.
These findings align with broader evidence showing that multicomponent interventions integrating informational content, professional guidance, and peer interaction produce statistically significant improvements in caregiver knowledge, mental health, stress, depression, burden, and self-efficacy.
"The opportunity to connect with others who understand the challenge of caregiving appears to mitigate feelings of loneliness and foster resilience."
IMPLICATIONS FOR PRIMARY CARE
More than 80% of family caregivers of dementia patients receive no formal training or support — a system-wide gap with direct consequences for patient outcomes and unnecessary utilization. Caregiver burnout is among the most predictable drivers of avoidable hospitalizations and premature nursing home placement.
PCPs have a meaningful opportunity to assess caregiver status and connect families with structured support resources as part of routine dementia care. Even a brief caregiver check-in at the point of cognitive assessment can identify families at high risk of crisis before it occurs.
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