A precision revolution is coming for Alzheimer’s

Oncology has been at the forefront of precision medicine for decades, transforming once-devastating cancer diagnoses into manageable and sometimes curable conditions. Meanwhile, neurology—and particularly Alzheimer's diagnosis and treatment—has trailed behind.  

Why has this gap been so persistent? For starters, it’s simply much harder to study the brain. Second, and just as important, there is a stigma in both understanding and diagnosing dementia. Globally, almost 62% of healthcare providers think dementia is part of normal aging and medical education often dedicates mere hours to long-term conditions like dementia. In the absence of a lab test to make a diagnosis, primary care physicians rely on heuristics and behavioral markers, only to present their patients with management strategies rather than disease-altering solutions.  

Yet today, we stand at an inflection point. The recent approvals of therapies that target one of the key hallmarks of Alzheimer's disease, namely the “plaques” formed by amyloid-beta proteins in the brain, as well as the development of blood-based biomarkers for Alzheimer's disease, signal a new era. As we navigate this crucial moment, what lessons can Alzheimer's research draw from oncology's precision revolution?

Understanding biological complexity  

Oncology's transformation began with a deepened understanding of tumor biology. Rather than relying on one-size-fits-all chemotherapy, we began to develop highly targeted treatments that could pinpoint specific cancerous cells. This profound leap forward was made possible by in-depth research in diagnostics and treatments, which revealed unique molecular signatures of various tumor types.  

We are just beginning to understand dementias like Alzheimer’s with this level of specificity. Current approaches to developing precision therapeutics focus on targeting amyloid-beta plaques as well as “tangles” caused by another protein, tau, but researchers are working to identify a larger web of biomarkers that will widen the targets for both diagnostics and treatments.  

Alzheimer’s is just one form of dementia: a wide range of diseases that all impact the brain and cognitive behavior. Since each type of dementia has its own unique molecular signatures in the brain, the more precisely we can identify the “molecular fingerprints” of each neurological condition, the better our chances of developing diagnostics and treatments that target the root of the disease with fewer side effects.  

Customized combinations  

Cancer treatment has dramatically evolved from a blunt force approach to a far more sophisticated one. The early days of chemotherapy treatments that destroy a wide range of cells—including healthy ones—have given way to more sophisticated approaches comprising a cocktail of precision targeted treatments. Alzheimer's treatment seems to be following a similar trajectory. In addition to amyloid-targeting therapies, we are seeing movement toward tau-targeting therapies, which open new avenues for disease-modifying treatments.  

Oncology made its greatest strides when it began matching therapies to specific patient subgroups based on biomarkers. Similarly, Alzheimer's research is shifting toward patient stratification based on biological indicators like amyloid and tau proteins.  

More sophisticated patient-identifying tools, including those powered by AI, also help us find patients at earlier stages of disease—even before they show symptoms. Much like with cancer, the earlier we can identify the disease, the better our chances of not only slowing its progression but also changing its trajectory.  

A greater understanding of dementia biomarkers can also inform how we think about the disease as part of a global system. Can we modify or influence risk factors, including lifestyle factors for comorbidities like cardiovascular disease or other metabolic diseases? This represents a potentially exciting shift from focusing solely on brain disease toward thinking holistically about supporting brain health.  

Challenges in precision neurology

But neurology faces unique challenges. Dementias like Alzheimer’s manifest primarily through behavior and cognition: subjective measures that vary widely between individuals and are difficult to standardize. When does forgetfulness become pathological? How do we separate personality from pathology?

As neurology diagnostics improve, we will also face profound ethical questions unique to brain diseases. What does it mean to have a positive amyloid biomarker without cognitive symptoms? How should this information be handled for someone like a 55-year-old surgeon who shows biological signs of Alzheimer's but no functional impairment?

Unlike many cancer biomarkers, which can be confirmed through additional tests or biopsies, brain biomarkers exist in an ambiguous space between biological risk and functional reality. The brain isn't just another organ—it's the seat of personality, identity, and consciousness. 

The future of precision neurology

Despite these challenges, there's reason for optimism. The field is experiencing unprecedented momentum, with blood-based biomarkers and targeted therapies that seemed impossible just years ago.  

The path forward requires learning from oncology's precision revolution while acknowledging neurology's unique landscape. By understanding the biological complexity of brain diseases, stratifying patients based on biomarkers, developing combination approaches and addressing implementation challenges, we can transform Alzheimer's care.

The journey from chemotherapy to precision oncology took decades of persistent research, careful observation, and continuous refinement. By applying lessons from oncology while respecting the unique nature of brain diseases, we can transform the outlook for millions facing cognitive decline worldwide.