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Increasing availability of clinically validated biomarkers including cerebrospinal fluid and positron emission tomography to assess both amyloid and tau pathology has led to a reconceptualisation of ad as a clinical\u2013biological diagnosis, rather than one based purely on clinical phenotype. However, co-pathology is frequent in older adults which influence the accuracy of biomarker interpretation. Importantly, some older adults with positive amyloid or tau pathological biomarkers may never experience cognitive impairment or dementia. These strides towards achieving an accurate clinical\u2013biological diagnosis are occurring alongside recent positive phase 3 trial results reporting statistically significant effects of anti-amyloid Disease-Modifying Therapies (DMTs) on disease severity in early ad. However, the real-world clinical benefit of these DMTs is not clear and concerns remain regarding how trial results will translate to real-world clinical populations, potential adverse effects (including amyloid-related imaging abnormalities), which can be severe and healthcare systems readiness to afford and deliver potential DMTs to appropriate populations. Here, we review recent advances in both clinical\u2013biological diagnostic classification and future treatment in older adults living with ad. Advocating for access to both more accurate clinical\u2013biological diagnosis and potential DMTs must be done so in a holistic and gerontologically attuned fashion, with geriatricians advocating for enhanced multi-component and multi-disciplinary care for all older adults with ad. This includes those across the ad severity spectrum including older adults potentially ineligible for emerging DMTs.<\/jats:p>","DOI":"10.1093\/ageing\/afae005","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T02:19:56Z","timestamp":1707704396000},"source":"Crossref","is-referenced-by-count":32,"title":["New horizons in the diagnosis and management of Alzheimer\u2019s Disease in older adults"],"prefix":"10.1093","volume":"53","author":[{"given":"Helena","family":"Dolphin","sequence":"first","affiliation":[{"name":"Discipline of Medical Gerontology , School of Medicine, , Dublin , Ireland"},{"name":"Trinity College Dublin , School of Medicine, , Dublin , Ireland"},{"name":"Institute of Memory and Cognition, Tallaght University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam H","family":"Dyer","sequence":"additional","affiliation":[{"name":"Discipline of Medical Gerontology , School of Medicine, , Dublin , Ireland"},{"name":"Trinity College Dublin , School of Medicine, , Dublin , Ireland"},{"name":"Institute of Memory and Cognition, Tallaght University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Morrison","sequence":"additional","affiliation":[{"name":"Discipline of Medical Gerontology , School of Medicine, , Dublin , Ireland"},{"name":"Trinity College Dublin , School of Medicine, , Dublin , Ireland"},{"name":"Institute of Memory and Cognition, Tallaght University Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan D","family":"Shenkin","sequence":"additional","affiliation":[{"name":"Ageing and Health Research Group , Advanced Care Research Centre, , Edinburgh , UK"},{"name":"Usher Institute, University of Edinburgh , Advanced Care Research Centre, , Edinburgh , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Welsh","sequence":"additional","affiliation":[{"name":"Bristol Medical School (THS), University of Bristol , Bristol , UK"},{"name":"RICE \u2013 The Research Institute for the Care of Older People , Bath , UK"},{"name":"Royal United Hospitals Bath NHS Foundation Trust , Bath , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean P","family":"Kennelly","sequence":"additional","affiliation":[{"name":"Discipline of Medical Gerontology , School of Medicine, , Dublin , Ireland"},{"name":"Trinity College Dublin , School of Medicine, , Dublin , Ireland"},{"name":"Institute of Memory and Cognition, Tallaght University Hospital , Dublin , 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