Early Alzheimer Diagnosis Key to Better Outcomes: Darla Chapman, DNP

Diagnosing Alzheimer disease early is critical to improving outcomes and quality of life for patients and their care partners, Darla Chapman, DNP, ARNP, nurse practitioner, University of Washington School of Medicine, explained. At the Institute for Value-Based Medicine event hosted by The American Journal of Managed Care® in Portland, Oregon, on October 21, 2025, Chapman delivered a session titled “Site of Care with Alzheimer’s Disease Management.”

In this interview, she discussed how diagnosis has evolved from symptom-based assessments to include advanced biomarker testing and imaging techniques that enable earlier detection. She also highlighted the current barriers to accessing disease-modifying treatments—from costly and specialized diagnostic requirements to logistical challenges in administering and monitoring therapies—underscoring ongoing gaps in equitable care access.

This transcript has been lightly edited; captions were auto-generated.

Transcript

Why is the early diagnosis of Alzheimer disease so important, and how has diagnosis evolved in recent years?

Traditionally, Alzheimer's disease was a diagnosis based on symptoms alone and by ruling out other reasons why someone might have cognitive changes, and it typically was made in the later stages of the disease. Unfortunately, what we've learned over time is that earlier diagnosis leads to better outcomes—helps us initiate sooner treatments that can delay progression, helps us implement care plans for both individuals living with memory loss and their care partners, things like education and support. Early diagnosis also gives us the opportunity to manage comorbidities or other health care conditions that can contribute to cognitive changes, and then also gives us the opportunity to really teach people lifestyle modifications such as exercise and healthy eating and social and mental engagement that we know can improve quality of life and outcomes.

There's been a lot of evolution recently in the diagnosis of Alzheimer's disease, a lot of effort being put into really trying to provide an earlier diagnosis; things like new brain imaging techniques, ways we can measure amyloid proteins, which are the hallmark pathology of Alzheimer's disease in both spinal fluid and blood. We're seeing this push with new biomarkers and modalities to make that diagnosis sooner. So it's moved from more of a symptoms-based diagnosis to one that is more symptoms- and biomarker-based, all in the effort to provide earlier diagnosis and better outcomes.

What are the current barriers to receiving disease-modifying Alzheimer treatment?

There are quite a few barriers that we're trying to work through. They require a biomarker test to verify that someone has the pathology of Alzheimer's disease, that amyloid plaque. And those tests can be expensive and are not typically performed outside of major medical institutions, so things like an amyloid PET scan or a lumbar puncture are usually done in specialty medicine clinics. We are hoping, with the evolution of blood-based biomarkers, that that could move into more of a primary care setting—at least initially.

The medications are given by IV, so they require an infusion center and a nursing staff, and they're given every 2 to 4 weeks, depending on the medication. For people who live far away who can't access major medical systems, this can create geographical disparities. Then, there is also a requirement for frequent brain imaging when one is receiving these medications because of a potential side effect called ARIA, or amyloid-related imaging abnormalities. People who take these drugs are at risk for little areas of brain bleeding or brain swelling, and therefore are required to get several surveillance brain MRIs throughout the course of treatment. Again, MRIs are usually in major medical institutions and require special reading and monitoring and surveillance. So, there are some limitations, at least, of right now, as to how we can offer those kind of therapies to people.