The p-Tau217 biomarker is one of the most exciting advances in neurology for decades, giving us a new opportunity to accurately predict and potentially prevent (or at least substantially delay) MCI and Alzheimer’s. That it rises so early in the course of the disease—which incubates over 20 years—gives us a long runway of opportunity to intervene, be it with lifestyle factors or drugs. I now refer to the former as lifestyle plus because it is no longer just about the details of diet, exercise and sleep. There are several other dimensions of modifiable factors.

An APOE4 allele or a polygenic risk score for Alzheimer’s tests are binary. They only tell us if a person has increased risk (yes or no) but not when. It makes a huge difference if that at age 98 or 68. With serial assessment of p-Tau217 (several months or years apart) as part of a comprehensive assessment using multimodal A.I., it is very likely that the temporal plot (see Figures under Question 2 above) can be defined at the individual level. I lay out the blueprint for this and lifestyle plus fully in Super Agers. Individuals with elevated p-Tau217 at high-risk many years before the onset of any symptoms creates a new path for surveillance and prevention. Multiple new drugs are in the pipeline to be part of a prevention program.

Even though it intuitively appears to be the case, more work needs to be done to determine whether lowering one’s p-Tau217 will alter the brain plaque progression and be seen as a disease-modifier. Clearly there is now a hunt for even better blood tests that may one day supersede p-Tau217 or be in a panel with it.