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A study of 186 attendees at a brain health service in Monza, Italy, found that many people reporting cognitive changes despite normal test performance had modifiable dementia risk factors. Among participants with subjective cognitive decline, elevated blood p-Tau217 was linked to signs of neurodegeneration; about 60% of those who received biomarker and risk information said it increased their motivation to make lifestyle changes.
A study of people attending a brain health service in Monza, Italy, found that reports of memory or thinking changes can coexist with normal performance on standard cognitive tests and a substantial burden of potentially modifiable dementia risks. Among participants with subjective cognitive decline, elevated blood levels of the Alzheimer’s-related biomarker p-Tau217 were associated with signs of neurodegeneration, while about 60% of those given personalized results said the disclosure increased their motivation to make lifestyle changes.
The study, published in Neurological Sciences, examined 186 consecutive service attendees, including 132 classified as having subjective cognitive decline, or SCD. People with SCD notice changes in their cognition but continue to perform normally on standard cognitive tests. The researchers characterized participants’ clinical, biological and imaging features and explored how they responded to information about biomarkers and estimated dementia risk.
For SCD participants with available blood results, researchers classified p-Tau217 levels as above or below a 0.15 pg/mL threshold. The report says elevated levels were linked to early signs of neurodegeneration. At a second visit, participants were told their p-Tau217 and APOE genotype results, along with an individualized dementia-risk estimate, and were offered targeted prevention recommendations. One week later, they completed online self-report questionnaires; about 60% reported greater motivation to make lifestyle changes after the disclosure.
The authors also described differences among attendees classified as SCD, mild cognitive impairment (MCI), functional cognitive decline, and “worried well.” They reported that the MCI group tended to be older and to show lower cognitive performance and higher levels of amyloid biomarkers, neurodegeneration and neuroinflammation. The researchers caution that these group comparisons are exploratory, in part because of the study’s sample size.
Why Normal Test Scores May Not End Assessment
The findings point to a gap between what a person experiences and what a brief or standard cognitive assessment detects. Normal test performance does not explain every reported memory concern, and SCD can have varied causes. In some people it may precede measurable impairment, but the study does not establish that an individual with SCD will develop dementia.
The results also illustrate why risk assessment may look beyond test scores. The researchers found potentially modifiable risks among people seeking help, while blood biomarkers offered another kind of information about possible Alzheimer’s-related biology. The disclosure findings suggest that sharing personalized estimates may prompt some people to consider prevention steps. However, motivation reported in a questionnaire is not proof that participants changed their habits or reduced their future dementia risk.
For readers with memory concerns, the study is not a diagnostic guide. It describes one service and its attendees; its results do not establish that everyone with subjective concerns should receive biomarker testing. Decisions about assessment or testing depend on individual circumstances and clinical guidance.
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The Debate Over Biomarkers in SCD
SCD is more common than mild cognitive impairment and is not a single condition. The source report notes that it can arise from neurodegenerative or non-neurodegenerative causes. Earlier research cited in the report suggests that, depending on the setting, as many as one-third of people with SCD may have preclinical Alzheimer’s disease; that estimate should not be treated as a prediction for any individual or for the Monza cohort.
Blood tests such as p-Tau217 are adding to debate about when Alzheimer’s disease should be identified and how results should be explained. The source says the 2024 Alzheimer’s Association criteria allow a biological definition based on abnormal biomarkers, including plasma markers, when the tests perform adequately in the population being assessed. But recommendations differ for people without measurable cognitive impairment: the Alzheimer’s Association workgroup advises against diagnostic biomarker testing in cognitively unimpaired people outside observational or therapeutic research, while the International Working Group generally describes biomarker-positive people without impairment as being at risk rather than as having Alzheimer’s disease.
The Monza service is part of a developing model that focuses on prevention as well as diagnosis. Brain health services can assess risk, communicate results and recommend risk-reduction measures; attendees may come through self-referral, primary care or a memory clinic. The study describes how one such service operates, not a universal standard of care.
“About 60% of participants who underwent disclosure reported greater motivation for lifestyle changes.”
— The study authors, as summarized by News-Medical
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What the Study Cannot Establish
The report does not establish that elevated p-Tau217 in a person with SCD will lead to dementia, or that biomarker testing improves long-term health outcomes. It also does not show whether the reported increase in motivation led to sustained behavior changes. Longer follow-up and outcome data are not provided in the supplied report.
The results come from 186 attendees at one service, and not every participant had available plasma biomarker results. The available source material does not give the number of SCD participants in each p-Tau217 category, the full prevalence figures for individual risk factors, or enough detail to assess how representative attendees were of the wider population. The study also does not resolve which people with SCD should be offered biomarker tests or how results should be used in routine care.
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Follow-Up Needed on Risk Disclosure
The immediate next step for interpreting these findings is further research that follows participants beyond the one-week questionnaire, measuring whether motivation translates into lasting lifestyle changes and whether those changes affect health outcomes. Larger studies across multiple services could test whether the patterns seen in Monza are repeated in different populations.
Until such evidence is available, the study adds real-world observations to an ongoing debate about biomarker testing and communication for people with memory concerns but normal cognitive test results. The authors’ reported approach combined individualized risk estimates with preventive recommendations; the supplied report does not identify a later clinical milestone or a change in testing guidance.
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Key Questions
What is subjective cognitive decline?
Subjective cognitive decline means a person notices a change in memory or thinking, even though standard cognitive tests remain within the normal range. It can have different causes and does not by itself mean a person has dementia.
What did the Monza study find about p-Tau217?
Among participants with SCD who had blood biomarker results, p-Tau217 levels at or above 0.15 pg/mL were associated with early signs of neurodegeneration, according to the study report. The finding does not establish that every person above the threshold will develop dementia.
Did sharing results lead to lifestyle changes?
About 60% said they felt more motivated to make lifestyle changes after receiving biomarker and risk information. Responses were collected one week later through self-reported questionnaires; the study report does not show whether participants changed their behavior or maintained changes over time.
Does this study mean everyone with memory concerns should get a blood test?
No. The study examined attendees at one brain health service and does not establish who should receive biomarker testing. Recommendations differ among expert groups, and testing decisions should be discussed with a qualified health professional.
Source: rss
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