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Cognitive health assessments and lab tests designed to enhance the Alzheimer’s disease and dementia care pathway

Alzheimer’s disease is the most common cause of dementia, affecting over 6M people in the US.1 Diagnosis and care for patients with cognitive impairment is rapidly evolving, making assessing Alzheimer’s disease pathophysiology, as well as other dementias, key to timely intervention.

Improvement of patient outcomes and care pathways drives our commitment to offer one of the industry’s most comprehensive portfolios of lab tests for Alzheimer’s disease and dementia to help assess potential risk.

Quest AD-Detect® is a portfolio of blood-based risk assessment offerings that can help provide better understanding of a patient’s potential risk for dementia or Alzheimer’s disease. For patients who may want a less invasive option, a simple blood test can be the first step in taking action and help to determine if more comprehensive testing is needed.

AD-DetectTM ABeta 42/40 and p-tau217 Evaluation

This panel combines Aβ 42/40 and p-tau217 plasma levels to help establish the likelihood of amyloid pathology consistent with Alzheimer's disease, evaluated at 91% sensitivity and 91% specificity—meeting accepted performance standards for blood-based biomarker tests.2,3

The biomarker values are combined into a single analytical interpretation, which has been shown to significantly improve predictive performance and accuracy for detecting amyloid positivity corresponding to the findings of an amyloid PET scan and establishing a diagnosis of Alzheimer's disease.


Quest AD-Detect® Beta-Amyloid 42/40 Ratio

This test assesses beta-amyloid 42/40 (Aβ42/40) ratio via plasma. This ratio measures levels of 2 beta-amyloid peptides, where certain ratio results may suggest a risk of developing Alzheimer’s disease.4 Blood-based amyloid testing provides an accessible, affordable tool as part of Alzheimer’s disease risk assessment and ongoing monitoring, aiding in evaluation of further comprehensive testing needs.


Quest AD-Detect® p-tau217

Plasma testing for the phosphorylated tau217 (p-tau217) biomarker can help assess whether mild cognitive impairment (MCI) or dementia is caused by Alzheimer’s disease.5-7

Current research indicates that plasma p-tau—including p-tau217—is concordant with amyloid status defined by either cerebrospinal fluid (CSF) biomarker testing or positron emission tomography (PET) scan analysis and has been shown to predict progression to Alzheimer’s disease.5-9 It can differentiate between Alzheimer’s disease and non-Alzhiemer's disease neurodegenerative conditions and identify patients who may benefit from further diagnostic testing.5-7


Quest AD-Detect® p-tau181

This test is used to detect phosphorylated tau (p-tau181) proteins, one of the hallmark biomarkers involved in the diagnosis and staging of Alzheimer’s disease. P-tau181 concentrations increase over time within plasma as Alzheimer’s disease progresses.10,11 Routine monitoring of p-tau181 levels via plasma is ideal to support care pathways as it is less invasive, less expensive, and more practical than other methods. Combined plasma p-tau and Aβ42/40 biomarker testing has been shown to help identify patients at risk of experiencing faster cognitive decline12 and which patients can benefit from further diagnostic testing.


Quest AD-Detect® Apolipoprotein (ApoE) Isoform

It’s critical to understand ApoE status for patients considering amyloid-modifying therapies. This test can provide insights on the presence of ApoE isoforms, a well-known biomarker associated with risk of developing Alzheimer’s disease.4 Insights into a patient’s ApoE status can help assess the risk of amyloid-related imaging abnormalities (ARIA) in patients considering amyloid-modifying therapeutics. Quest (data on file) and others13,14 have shown that the results of phenotyping are 100% concordant with ApoE genotyping results.

Blood-based test to assess neuronal damage from neurodegenerative diseases, such as Alzheimer’s disease and multiple sclerosis (MS), and traumatic brain injury (TBI) like that caused by concussions.

Neurofilament light chain (NfL) is a neuron-specific protein routinely released into the extracellular space of the brain. Serum NfL levels rise above baseline in response to neuronal injury and neurodegeneration.

This test measures beta-amyloid 40 (Aβ40) as well as Aβ42 in CSF, rather than Aβ42 alone. Using the ratio of Aβ42/40 improves sensitivity and specificity for Alzheimer’s patients.

This test combines ApoE results with Aβ42/40 ratio into an algorithm to assess Alzheimer’s disease risk, and can help assess the risk of amyloid related imaging abnormalities (ARIA) in patients considering amyloid-modifying therapeutics.

This test combines 3 biomarkers, phospho-tau, total tau, and Aβ42, to help you provide clinically relevant information regarding Alzheimer’s disease staging that may help guide patient management.

This test can provide insights into a patient’s ApoE status. ApoE is a key biomarker associated with an increased risk of developing Alzheimer’s disease.15

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References

1. CDC. About dementia. Updated August 17, 2024. Accessed February 25, 2025. https://www.cdc.gov/alzheimers-dementia/about/index.html

2. Weber DM, Stroh MA, Taylor SW, et al. Development and clinical validation of blood-based multibiomarker models for the evaluation of brain amyloid pathology. medRxiv 2025;02.27. doi: 10.1101/2025.02.27.25322892

3. Schindler SE, Galasko D, Pereira AC, et al. Acceptable performance of blood biomarker tests of amyloid pathology — Recommendations from the Global CEO Initiative on Alzheimer’s disease. Nat Rev Neurol. 2024;20(7):426-439. doi:10.1038/s41582-024-00977-5

4. Nakamura A, Kaneko N, Villemagne V, et al. High performance plasma amyloid-B biomarkers for Alzheimer’s disease. Nature. 2018;554(7691):249-254. doi:10.1038/nature25456

5. Thijssen EH, Joie RL, Strom A, et al. Plasma phosphorylated tau 217 and phosphorylated tau 181 as biomarkers in Alzheimer’s disease and frontotemporal lobar degeneration: a retrospective diagnostic performance study. Lancet Neurol. 2021;20(9):739-752. doi:10.1016/s1474-4422(21)00214-3


6. Palmqvist S, Janelidze S, Quiroz YT, et al. Discriminative accuracy of plasma phospho-tau217 for Alzheimer disease vs other neurodegenerative disorders. JAMA. 2020;324(8):772-781. doi:10.1001/jama.2020.12134


7. Ashton NJ, Brum WS, Molfetta GD, et al. Diagnostic accuracy of a plasma phosphorylated tau 217 immunoassay for Alzheimer disease pathology. JAMA Neurol. 2024;81(3):255-263. doi:10.1001/jamaneurol.2023.5319


8. Mielke MM, Dage JL, Frank RD, et al. Performance of plasma phosphorylated tau 181 and 217 in the community. Nat Med. 2022;28(7):1398-1405. doi:10.1038/s41591-022-01822-2


9. Therriault J, Ashton NJ, Pola I, et al. Comparison of two plasma p-tau217 assays to detect and monitor Alzheimer’s pathology. eBioMedicine. 2024;102:105046. doi:10.1016/j.ebiom.2024.105046


10. Lantero Rodriguez J, Karikari TK, Suárez-Calvet M, et al. Plasma p-tau181 accurately predicts Alzheimer’s disease pathology at least 8 years prior to postmortem and improves the clinical characterisation of cognitive decline. Acta Neuropathol. 2020;140(3):267-278. doi:10.1007/s00401-020-02195-x


11. Brickman AM, Manly JJ, Honig LS, et al. Plasma p-tau181, p-tau217, and other blood-based Alzheimer’s disease biomarkers in a multi-ethnic, community study. Alzheimers Dement. 2021;17(8):1353-1364. doi:10.1002/alz.12301


12. Meyer PF, Ashton NJ, Karikari TK, et al. Plasma p-tau231, p-tau181, PET biomarkers, and cognitive change in older adults. Ann Neurol. 2022;91(4):548-560. doi:10.1002/ana.26308

13. Nishimura M, Satoh M, Nishimura S, et al. Human apolipoprotein E resequencing by proteomic analysis and its application to serotyping. PLoS ONE. 2014;9(1):e85356. doi:10.1371/journal.pone.0085356


14. Kirmess KM, Meyer MR, Holubasch MS, et al. The PrecivityAD™ test: accurate and reliable LC-MS/MS assays for quantifying plasma amyloid beta 40 and 42 and apolipoprotein E proteotype for the assessment of brain amyloidosis. Clin Chim Acta. 2021;519:267-275. doi:10.1016/j.cca.2021.05.011


15. Kim J, Basak JM, Holtzman DM. The role of apolipoprotein E in Alzheimer’s disease. Neuron. 2009;63(3):287-303. doi:10.1016/j.neuron.2009.06.026