Is it time to change the way we detect Alzheimer’s disease and monitor its progression? Towards affordable and theory-driven approaches from cognitive neurosciences

A large proportion of people suffering from Alzheimer’s disease (AD) worldwide are not receiving a timely diagnosis. The tools currently used to detect AD and monitor its progression are not sensitive to the preclinical stages and lack specificity for correctdiagnosis. Available biomarkers show acceptable levels of sensitivity but remain littlespecific and not accessible to everyone. We embrace the view that enhancing cognitive assessment of AD should be a research priority. This Perspective paper focuses on issues which, to our view, have been preventing cognitive tests from meeting outstanding needs in the early of detection, monitoring, and treatment development of AD dementia.We first outline the limitations of current diagnostic procedures both theoretically and practically. We then provide a rationale for theory-driven cognitive approaches which would allow mapping assessment tools to specific neuropathological stages of the neurodegenerative course of AD. Finally, we propose research strategies that would help test a hypothesis which, though launched five years ago, remains untested.That is: “Which memory system is impaired first in Alzheimer’s disease?”