Beyond the Memory Test: Why the Future of Cognitive Assessment Must Be Multidimensional
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Memory loss has long been considered the defining hallmark of Alzheimer’s disease. But there is more to the disease than misplaced keys, forgotten names, and other memory lapses. Reducing Alzheimer’s to memory alone oversimplifies a disease that affects multiple aspects of thinking, behavior, and daily functioning.
As researchers develop more sophisticated biomarkers, disease-modifying therapies, and prevention strategies, they also recognize that the tools used to measure cognition must evolve. Alzheimer’s affects far more than memory, and understanding the disease requires assessing the full range of cognitive and behavioral changes that patients experience.
This theme emerged during the third episode of “The Progress Profile: Alzheimer’s Research in Focus,” in which Maria Carrillo, Ph.D., chief science officer and medical affairs lead at the Alzheimer’s Association, joined moderator Dr. John Harrison to discuss why the field is broadening its view of cognitive decline.
Looking beyond memory
While memory remains one of the hallmark symptoms of Alzheimer’s disease, it is only one component of cognition. Executive function, attention, language, processing speed, visuospatial abilities, and behavior can all change as the disease develops (and they may not all change at the same pace).
The episode highlighted an encouraging shift in how researchers think about measurement, including tools to assess domains such as executive function and attention, reflecting a growing understanding that no single aspect of cognition can fully capture the complexity of Alzheimer’s disease.
Capturing these changes provides a more complete picture of disease progression and may reveal subtle changes that traditional memory-focused assessments miss.
The conversation also highlighted an area that has historically received less attention: behavioral symptoms.
“Sometimes there are behavioral changes that … individuals experience, and their loved ones might be noticing [that] we think of this as purely memory,” Carrillo explained. “But it’s not that, there are so many other components that go into thinking and behavior, and we have to be including those as well.”
Behavior changes such as increased anxiety, apathy, impulsivity, irritability, or social withdrawal may be dismissed as normal aging or unrelated mental health concerns. Increasingly, researchers are investigating whether these behavioral changes can serve as early indicators of neurodegenerative disease.
Recognizing these symptoms alongside cognitive changes could help clinicians better understand where patients are in the disease process and how Alzheimer’s manifests differently from one individual to another.
The evolution of cognitive assessment
Traditional cognitive testing was designed primarily to identify impairment once symptoms became apparent, but Carrillo noted that scientific advancements are changing how we approach the detection, diagnosis, and treatment of Alzheimer’s disease.
- Blood biomarkers make it possible to identify Alzheimer’s pathology earlier than ever before.
- Disease-modifying therapies shift attention toward intervention in the earliest stages of disease.
- Clinical trials enroll participants with increasingly subtle symptoms or even those who have biological evidence of disease before noticeable cognitive decline.
As the field evolves, cognitive assessments must evolve alongside it.
Carrillo pointed to research presented at the 2026 Alzheimer’s Association International Conference showing that a simple blood test for pTau217 helped primary care physicians feel significantly more confident in diagnosing Alzheimer’s disease. These advances may also lead to earlier diagnosis.
In asymptomatic individuals, Carrillo noted, it might be possible to develop a risk profile. Blood tests could reveal whether the risk of developing symptoms was imminent or an individual had a five- to 10-year window in which they were likely to remain symptom-free.
Carrillo emphasized that these tools must be used thoughtfully and with appropriate guidance for clinicians and patients, especially because of their potential to affect insurance coverage.
“We certainly know now that life insurance and long-term care insurance are dependent on healthy brains; they will not insure you,” she explained. “However, we do not know what will change in the future when it comes to medical coverage.”
Coverage could be denied even for those who are healthy but have amyloid in their medical records. As a result, she stressed, individuals considering biomarker testing must contemplate all the possible ramifications.
The podcast also explored the role of stigma, which remains a major issue, according to Carrillo. As treatments for Alzheimer’s disease and related dementias improve, there will be the first survivors, and that, she said, “changes the story.”
The future of Alzheimer’s care
As the Alzheimer’s field enters a new era focused on earlier detection, individualized treatment, and prevention, that transformation requires a corresponding shift in how cognition is measured, how risk can be reduced, and what efforts can be made at the individual level.
“We don’t know enough about brain health. I think it’s important that we all recognize that [brain health] is important, from the earliest ages possible, and it is not necessarily a cure for dementia, but it certainly can be a risk reducer,” Carrillo said. “And so, we should all be thinking along those lines and trying to educate ourselves about what that means for me: As a person, what might I be able to change? What is within my scope and reach to be able to change to improve my brain health?”
For additional insights on the ethical considerations surrounding early biomarker testing, the progress being made in prevention, diagnosis, and treatment, and the practical steps needed to ensure new scientific advances translate into better care, listen to episode three of “The Progress Profile: Alzheimer’s Research in Focus.”