When Alzheimer's disease prevention becomes policy: regulatory speed, commercialisation, and risk

As Alzheimer's disease research focuses on earlier and asymptomatic stages, and as biomarker technologies advance, attention has turned to the feasibility of preventing cognitive impairment rather than treating established dementia. In their Policy View, 1 Eric Reiman and colleagues argue that the Alzheimer's disease research, regulatory, and care community, including investigators, regulators, payers, industry, and health systems, should urgently prepare for the imminent prevention of clinical Alzheimer's disease. They contend that advances in disease-modifying therapies, blood biomarkers, and scalable cognitive tools have rendered prevention a realistic near-term goal. Their Policy View is comprehensive and motivated by a desire for early treatment. Yet its core message—that readiness should advance in parallel with evidentiary maturation—underestimates the conflicting forces shaping Alzheimer's disease research and policy. In the current US academic, regulatory, and commercial environment, preparation for prevention treatments does not remain neutral; rather, it creates a research direction.