{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:51:45Z","timestamp":1791215505311,"version":"4.1.0"},"reference-count":35,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"abstract":"\n Importance<\/jats:title>\n Blood-based biomarkers show high performance for detecting Alzheimer disease (AD) pathology, but evidence on their impact on diagnostic certainty, clinical management, and emotional outcomes in routine care is limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether earlier disclosure of plasma phosphorylated tau at threonine 217 (p-tau217) and neurofilament light chain (NfL) increases etiologic diagnostic certainty, influences clinical management, and affects emotional outcomes in individuals evaluated for cognitive symptoms.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a prospective randomized clinical trial conducted at a single memory clinic in Spain between February and October 2024, with 9 months of follow-up. Consecutive new outpatients with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or mild dementia without a prior etiologic diagnosis were enrolled. Of 265 eligible participants, 220 were randomized to earlier disclosure of blood-based biomarkers at the 3-month visit or delayed disclosure at the 9-month visit.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Disclosure of blood-based biomarkers for AD pathology (p-tau217) and neurodegeneration (NfL) to the treating neurologist and participant, alongside standard clinical evaluation.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the proportion of participants achieving a very high-confidence etiologic diagnosis (\u226590%). Secondary outcomes included changes in clinical management and emotional outcomes (anxiety, depression, perceived stress, and quality of life).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 220 randomized participants (median [IQR] age, 73 [68-78] years; 123 [55.9%] women), baseline diagnoses were SCD (100 [45.5%]), MCI (68 [30.9%]), and mild dementia (52 [23.6%]). At 3 months, a very high-confidence etiologic diagnosis was achieved in 56 of 112 participants in the earlier-disclosure arm (50.0%) compared with 5 of 108 in the delayed-disclosure arm (4.6%) (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Diagnostic certainty converged after disclosure in both arms, except among participants with MCI, in whom higher certainty persisted in the earlier-disclosure arm. Earlier disclosure was associated with more frequent initiation of symptomatic AD treatment (16\/112 [14.3%] vs 5\/108 [4.6%]; difference, 9.7; 95% CI, 1.8 to 17.8;\n P<\/jats:italic>\n \u2009=\u2009.01), fewer planned follow-up neuropsychological reassessments for diagnostic clarification (34\/112 [30.4%] vs 57\/108 [52.8%]; difference, \u221222.4; 95% CI, \u221234.4 to \u22129.4;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and more planned discharge from the memory clinic to primary care (35\/112 [31.3%] vs 13\/108 [12.0%]; difference, 19.2; 95% CI, 8.4 to 29.5;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Earlier disclosure was not associated with worse emotional outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, earlier disclosure of blood-based biomarkers increased etiologic diagnostic certainty and led to earlier, targeted clinical management without increasing emotional distress. These findings support the integration of blood-based biomarkers into memory clinic diagnostic pathways.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT06246019<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaneurol.2026.3497","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:00:40Z","timestamp":1791212440000},"source":"Crossref","is-referenced-by-count":0,"title":["Earlier Disclosure of Blood-Based Biomarkers, Diagnostic Certainty, and Clinical Management"],"prefix":"10.1001","author":[{"given":"Isabel","family":"Estragu\u00e9s-G\u00e1zquez","sequence":"first","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Contador","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leidy Dayana","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Fern\u00e1ndez-Lebrero","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Garc\u00eda-Escobar","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Navalpotro-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"},{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriol","family":"Grau-Rivera","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual 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Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Ortiz-Romero","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Hern\u00e1ndez-Villamizar","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"},{"name":"Department of Biochemistry and Molecular Biology, Universitat Aut\u00f2noma de Barcelona, Bellaterra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Torres-Torronteras","sequence":"additional","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"de Diego-Osaba","sequence":"additional","affiliation":[{"name":"Barcelona Brain Health Center, Department of Neurology, Hospital del Mar, Barcelona, Spain"},{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Blasco-Forni\u00e9s","sequence":"additional","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Jim\u00e9nez-Moyano","sequence":"additional","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Jos\u00e9","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Laboratori de 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