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Review
. 2025 Aug;21(8):e70536.
doi: 10.1002/alz.70536.

Modernizing diagnosis of Alzheimer's disease: A review of global trends and Asia-specific perspectives

Affiliations
Review

Modernizing diagnosis of Alzheimer's disease: A review of global trends and Asia-specific perspectives

Takeshi Iwatsubo et al. Alzheimers Dement. 2025 Aug.

Abstract

The landscape of Alzheimer's disease (AD) and related dementias (ADRD) diagnosis is evolving rapidly, driven by advances in disease understanding, biomarker tools, and disease-modifying therapies. Modern diagnostic approaches emphasize biological precision, early detection, and dynamic frameworks that adapt to treatment-induced changes in disease biology. These frameworks enable opportunities for personalized interventions-encompassing pharmacological and non-pharmacological strategies-and for enhanced clinical trial design. However, implementing these advancements globally is influenced by diverse cultural, infrastructural, and regulatory factors. The 2024 Alzheimer's Association International Conference Advancements: Modernizing Diagnosis, held in Japan, provided a unique platform to explore these global dynamics, particularly from an Asian perspective. This article highlights key discussions from the conference, exploring the role of biomarker-based diagnostic frameworks in shaping the future of AD/ADRD research, diagnosis, and treatment. We highlight regional challenges and successes and emphasize ethical considerations and practical strategies needed to ensure equitable access to diagnostic and therapeutic innovations. HIGHLIGHTS: Advances in biomarkers are reshaping Alzheimer's disease diagnosis and treatment. Modern diagnostic frameworks highlight biological precision, early detection, and dynamic frameworks. The 2024 Alzheimer's Association International Conference Advancements: Modernizing Diagnosis explored challenges and opportunities in global biomarker implementation. The conference explored geographic-specific impacts, focusing on Asia.

Keywords: Alzheimer's disease; Asia; biomarker; dementia; diagnosis.

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Conflict of interest statement

M.C. Carrillo is a full‐time employee of the Alzheimer's Association; received support from NIA, and grants or contracts from NIA and CDC. As a full‐time employee of the Alzheimer's Association, all travel expenses are covered by her employer. Participated on a data safety monitoring board or advisory board of NIA and NINDS funded initiatives including ADSP. Reports the following leadership or fiduciary roles: GHR Foundation—board, and American Heart Association—Research Committee (unpaid, no longer active). Her daughter is a neuroscience graduate student at USC. S. Mahinrad is a full‐time employee of the Alzheimer's Association. C. Sexton is a full‐time employee of the Alzheimer's Association. I.C. Fontana is a full‐time employee of the Alzheimer's Association. H.M. Snyder is a full‐time employee of the Alzheimer's Association. Received grants or contracts from NIA and CDC. As a full‐time employee of the Alzheimer's Association, all travel expenses are covered by her employer. Participated on the data safety monitoring board or advisory board (all external advisory board) of NIA and NINDS funded initiatives including DISCOVERY AD and Microbiome AD/ADRD studies, and NACC EAB. She reports the following leadership or fiduciary roles: Health Research Alliance—board (unpaid, past); American Heart Association—research committee (unpaid); liaison—Brain Health Council, American Heart Association (unpaid); Women's Brain Health Committee—AARP (unpaid); CDMRP, DoD Alzheimer's and Related Disorders Committee—Chair (unpaid); and XPrize Judge (unpaid). Her spouse works for Abbott in an unrelated area. T. Iwatsubo has received honoraria from Eisai and Eli Lilly. R.A. Sperling has served as a paid consultant for AbbVie, AC Immune, Acumen, Alector, Apellis, Biohaven, Bristol Myers Squibb, Genentech, Ionis, Janssen, Oligomerix, Prothena, Roche, and Vaxxinity. She has received research funding from Eisai and Eli Lilly for public–private partnership clinical trials and receives research grant funding from the National Institute on Aging/National Institutes of Health, GHR Foundation, and the Alzheimer's Association. Her spouse, K. Johnson, reports consulting fees from Novartis, Prothena, Merck, and Janssen. A. Algeciras‐Schimnich serves on advisory boards for Roche Diagnostics and Fujirebio Diagnostics and received speaker honoraria from Roche Diagnostics. T.L.S. Benzinger has received grants or contracts from Siemens paid to her institution; consulting fees from Biogen** ($5,000–10,000), Eli Lilly, Eisai** ($5,000–10,000), Bristol Myers Squibb, J&J, and Merck; payment for CME activity from Medscape, PeerView, and Neurology Today; and travel reimbursement from Cedars Sinai Medical Center, Hong Kong Neurological Association, and the Alzheimer's Association. T.L.S.B. reports the following patents planned, issued or pending: US patent 16/097, 457 (DIFFUSION BASIS SPECTRUM IMAGING (DBSI), A NOVEL DIFFUSION MRI METHOD USED TO QUANTIFY NEUROINFLAMMATION AND PREDICT ALZHEIMER'S DISEASE (AD) PROGRESSION), and US Patent 12,016,701 (Quantitative Differentiation of Tumor Heterogeneity Using Diffusion MR Imaging Data). T.L.S.B. has participated on a data safety monitoring board or advisory board of Siemens and served as an external advisor for NIH‐funded studies (no payments). T.L.S.B. has served as the co‐chair of ASNR Alzheimer's, ARIA and Dementia Study Group, and RSNA Quantitative Imaging Committee (QuIC) (all unpaid). T.L.S.B. has served as a committee member of the American College of Radiology/ALZ NET imaging, NIH CNN Study Section Chair, and had a leadership or fiduciary role in the ACR Commission on Neurology (all unpaid). T.L.S.B. has received technology transfer and precursors for radiopharmaceuticals from Avid Radiopharmaceuticals/Eli Lilly, LMI, and Lantheus, as well as a scanner loan from Hyperfine to her institution. For additional references regarding T.L.S.B. disclosures, see Sunshine ACT reporting here: https://openpaymentsdata.cms.gov/physician/850680. C. Chen has received grants or contracts from the National Medical Research Council of Singapore and has received support from the Alzheimer's Association for attending meetings and/or travel. J. Graff‐Radford has participated on DSMB for NINDS strokeNET; served as the site investigator for trials sponsored by Eisai and Cognition Therapeutics; has received NIH funding; and received payment or honoraria as a course director from the American Academy of Neurology and as a faculty from IMPACT AD, clinical trial course. J.D. Grill has received research support from NIA, the Alzheimer's Association, BrightFocus Foundation, Eli Lilly, Genentech, Biogen, and Eisai; has received travel support from the Alzheimer's Association and personal compensation for editorial service to Alzheimer's & Dementia. J. Heidebrink received grants from Biohaven, Cognition Therapeutics, Eli Lilly, Eisai, NIH/NIA; travel support from Alzheimer's Association to attend meetings; and honorarium as a faculty member for IMPACT‐AD clinical trials course (funded by grants from NIH and Alzheimer's Association). R. Ihara has received honoraria from Eisai, Eli Lilly, Fujirebio and Sysmex, PDR Pharma, Nihon Medi‐Physics, and IQVIA; participated on a data safety monitoring board or advisory board of Eisai, Eli Lilly, and MSD; and had leadership or fiduciary role in Japan Society for Dementia Research. T. Ikeuchi received grants or contracts from KAKENHI; consulting fees from FujiRebio, Eli Lilly, Sysmex, Eisai, and Novo Nordisk; and payment or honoraria from Eisai, PDR Pharma, FujiRebio, Kowa Pharmaceuticals, and Eli Lilly. A. Iwata has received advisory fees from Eisai, Eli Lilly, Biogen, Ohtsuka, Dream medical partners, Sound wave Innovation, and UCB; honoraria from Eisai, Eli Lilly, Biogen, Ohtsuka, Daiichi Sankyo, Sysmex, Fujirebio, Janssen pharmaceutical, MSD, and UCB; research grants from Eisai, Eli Lilly, Sysmex, Fujirebio, Fujifilm, SONY, MSD, Biogen, and Kobayashi Pharmaceuticals. F.C.F. Ip is a full‐time employee of Hong Kong Center For Neurodegenerative Diseases; received consulting fees from Cognitact Limited; has two patents licensed to Cognitact; and has stock or stock options in Cognitact Limited. C.R. Jack Jr. is employed by Mayo Clinic. He receives research grant funding from the National Institutes of Health, the Alexander family professorship, and the GHR Foundation. Within the past 36 months, he served on a DSMB for Roche pro bono; no payments to the individual or institution were involved. He has received funding from the Alzheimer's Association for travel to scientific meetings. H. Kowa received honoraria from Eisai and Eli Lilly. R.L. Joie consulted for GE Healthcare; received support for attending meetings and/or travel from the Alzheimer's Association; and grants or contracts from NIH, Alzheimer's Association, and US DoD. Y. Niimi belonged to the endowed chair; Department of Healthcare economics and Health policy supported by NN Life Insurance Company, Ltd.; and belongs to the endowed chair; Dementia Inclusion and Therapeutics supported by Effissimo Capital Management Pte Ltd. R. Noritake received consulting fees from Syneos Health Japan and AstraZeneca. O.C. Okonkwo reports grants from NIH; and leadership or fiduciary role in the International Neuropsychological Society. S. Palmqvist received grants or contracts from Avid Pharmaceuticals and Ki elements/ADDF (both paid to the institution); received payment or honoraria from Eli Lilly, Eisai, BioArctic, and Novo Nordisk for lectures, presentations, speakers bureaus, manuscript writing, or educational events; and participated on a data safety monitoring board or advisory board of Eli Lilly, Eisai, and BioArctic. M.S. Rafii received grants from Eisai and Lilly. He is a consultant for Ionis and AC Immune and serves on the DSMB for Biohaven and on the Scientific Advisory Board for Prescient Imaging, Positrigo, and Embic. R. Raman receives grant funding from the National Institutes of Health, Eisai, Alzheimer's Association, and the American Heart Association; travel support for participating in the Alzheimer's Association's managed conferences when a scientific committee member or invited speaker; is an emeritus Board member (unpaid) of Alzheimer's Association San Diego/Imperial Chapter. Y. Shen received grants or contracts and support for attending meetings/travel from the Chinese Academy of Sciences (XDB39000000) and Nature Science Foundation (31530089). T. Simuni has, in the last 12 months, served as a consultant for AskBio, Blue Rock Therapeutics, Critical Path for Parkinson's Consortium (CPP), Denali, Centessa, Genentech, MJFF, Prevail/Lilly, Roche/Genentech, Ventus, Sinopia, Ventyx, TrueBinding, and Vanqua Bio; has equity in Sinopia and has served on the ad board for Biohaven, GE, GAIN, Genentech, FDA, Neuron23, Parkinson Study Group, Prevail/Lilly and Roche/Genentech; has served as a member of the scientific advisory board of Koneksa and UCB; and has received research funding from MJFF, Neuroderm, NINDS, Parkinson's Foundation Prevail, Roche, and UCB. W.M. van der Flier has been an invited speaker at Biogen MA Inc, Danone, Eisai, WebMD Neurology (Medscape), NovoNordisk, Springer Healthcare, European Brain Council with all funding paid to her institution; is a consultant to Oxford Health Policy Forum CIC, Roche, Biogen MA Inc, and Eisai, all funding paid to her institution; participated in advisory boards of Biogen MA Inc, Roche, and Eli Lilly; is a member of the steering committee of phase 3 EVOKE/EVOKE+ studies (NovoNordisk), all funding paid to her institution; is a member of the steering committee of PAVE, and Think Brain Health; is a member of the Scientific Leadership Group of InRAD; was associate editor of Alzheimer, Research & Therapy in 2020/2021; is associate editor at Brain; is a member of supervisory board (Raad van Toezicht) Trimbos Instituut. H. Wang is a global advisory board member, Eisai Inc., and is served as president of the Chinese Society of Geriatric Psychiatry (unpaid). D.M. Wilcock received support for attending Alzheimer's Association International Conference (in 2022, 2023, and 2024) and AD/PD (in 2022, 2023, and 2024); participated on a data safety monitoring board or advisory board of BU‐ADRC EAB, Michigan ADRC EAB, UAB‐ADRC EAB, USC‐ADRC EAB, South Texas ADRC EAB, Phenotype Harmonization Consortium EAB, Fun‐Gen Consortium EAB, Synaps‐Dx SAB, Longeveron SAB, and Vigil Neuroscience SAB; serves as the editor‐in‐chief of Alzheimer's & Dementia journal. H. Zetterberg has served on scientific advisory boards and/or as a consultant for Abbvie, Acumen, Alector, Alzinova, ALZpath, Amylyx, Annexon, Apellis, Artery Therapeutics, AZTherapies, Cognito Therapeutics, CogRx, Denali, Eisai, Enigma, LabCorp, Merry Life, Nervgen, Novo Nordisk, Optoceutics, Passage Bio, Pinteon Therapeutics, Prothena, Quanterix, Red Abbey Labs, reMYND, Roche, Samumed, Siemens Healthineers, Triplet Therapeutics, and Wave; has given lectures sponsored by Alzecure, BioArctic, Biogen, Cellectricon, Fujirebio, Lilly, Novo Nordisk, Roche, and WebMD; is chair of the Alzheimer's Association Global Biomarker Standardization Consortium and chair of the IFCC WG‐BND; and is a co‐founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program (outside submitted work). J. Zhou is a full‐time employee of Eisai Inc. The rest of the authors have no disclosures. The content of this manuscript is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health or the federal government. Author disclosures are available in the supporting information.

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