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Alzheimer's Disease: Primary Care Updates

Lisa Mathis MSN, FNP-BC : September 23, 2026

NPACE Notes Physician Assistant Nurse Practitioner Advanced Practice Provider Alzheimer's
Alzheimer's Disease: Primary Care Updates
Alzheimer's Disease: Primary Care Updates
5:15

Alzheimer's Disease: Primary Care Updates

By: Lisa Mathis, MSN, FNP-BC

Diagnosis, treatment, and the science of Alzheimer's disease (AD) continue to evolve. Clinicians now have a clearer definition of disease, blood tests for use even in primary care, and disease-modifying therapies that patients can self-inject at home. Primary care NPs and PAs are the first line for patients and likely to be the first a patient or family member shares cognitive concerns with.

 

Alzheimer's Defined Biologically

In 2024, an Alzheimer's Association workgroup redefined AD as a biological process that begins with neuropathologic change, often years before symptoms appear.¹ This framework brings testing and new biomarkers called Core 1 and Core 2.1-4 Under this framework, an abnormal Core 1 biomarker (amyloid PET, specific cerebrospinal fluid markers, or plasma phosphorylated tau 217) is enough to establish biological diagnosis. Core 2 biomarkers, then assist in staging and prognosis.¹ Amyloid build up and tau clumping remain the defining pathologies. Vascular dysfunction, neuroinflammation, and genetic risk also contribute.3,⁴ Currently in genetics, the APOE ε4 allele is the strongest known genetic risk factor. One copy raises risk 3 to 4-fold. Two copies raise risk 8 to 10-fold.³

 

When to Suspect

The Alzheimer's Association's 2024 clinical practice guidelines recommend structured evaluation whenever patient, care partner/family member, or clinician notices changes in cognition, behavior, or function.² Do not dismiss concerns as normal aging.
Common early signs in primary care include:

    • Missed appointments or new trouble managing medications
    • Difficulty with finances, driving, or other complex daily tasks
    • Repeated questions or stories within a single visit
    • Concerns raised by family members that the patient minimizes

Recommended workup includes a detailed history, validated cognitive assessment, laboratory testing, and structural brain imaging (MRI or CT). Review medication list for drugs with strong anticholinergic effects, per 2023 AGS Beers Criteria. Differential consideration includes depression, sleep disorders, hearing loss, and metabolic causes.

 

Blood Biomarkers

In 2025, the Alzheimer's Association released its first guidelines on blood-based biomarker tests, recommending tests with at least 90% sensitivity and 75% specificity for triage (ruling out AD pathology). It also warns that many commercially available tests do not meet thresholds and testing should never come before a full clinical evaluation.5,6 As of August 2026, the FDA cleared four blood tests for AD. Most recently a single-analyte plasma p-tau217 assay cleared to rule amyloid pathology in or out in both primary and specialty care.7,8 At the 2026 Alzheimer's Association International Conference, investigators presented a Swedish study in which primary care diagnostic accuracy for AD rose from 65% to 93% when clinicians had blood biomarker results, nearly matching specialists.⁹

Keep limits in mind including use only on symptomatic patients with a thorough history and assessment, note interfering factors like CKD or that even handling can affect results, and that lab is not stand alone for diagnosis. 7-9

 

Medications Patients May Be Taking

Two anti-amyloid monoclonal antibodies, lecanemab and donanemab, are approved for mild cognitive impairment or mild dementia due to AD in patients with confirmed amyloid pathology. They modestly slow decline but don’t arrest.⁵ Both carry boxed warnings for amyloid-related imaging abnormalities (ARIA), including brain edema and microhemorrhage. Specialists manage these medications and some additional testing is needed with some infusions. Consult medication criteria. Subcutaneous lecanemab is now approved for maintenance and, as of July 2026, for starting treatment. Patients may give themselves weekly injections at home.10,11

What this means for primary care:

    • Keep medication list current
    • Recognize possible ARIA: Headache, confusion, visual changes, gait problems, or seizures should raise concern. Contact the prescribing team promptly.
    • Check before anticoagulating and consult specialty team

Cholinesterase inhibitors and memantine are still standard symptomatic treatments. Research on tau-targeted, anti-inflammatory, and multi-target therapies continues.12

 

Bottom Line

Primary care clinicians are central to early detection. Take cognitive concerns seriously, complete structured evaluation, use blood biomarkers carefully in symptomatic patients, and learn to recognize complications in patients on anti-amyloid therapy.

 

References