Diversity and real-world representation in Alzheimer’s disease

Alzheimer’s disease (AD) does not affect all populations equally. Black and Hispanic individuals are much more likely to develop dementia than their white counterparts,^1,2 yet these populations have historically been underrepresented in both clinical research and biomarker studies,² affecting the generalizability of biomarker findings. For example, while increased blood levels of p-Tau217 are a highly accurate, robust biomarker for detecting brain ß-amyloid (Aß) pathology in white populations, there have been mixed results in Black populations.^2,3

Several factors have contributed to underrepresentation in AD studies—and all clinical studies. Historical mistrust of medical research, limited access to specialty care centers, transportation barriers, financial constraints, language differences, and lack of awareness about research opportunities can all reduce participation.^4,5 Clinical studies have often relied on participants who live near major academic centers and have the time and resources required for repeated visits, advanced imaging procedures, or cerebrospinal fluid collection.⁵ While these cohorts have generated important discoveries, they do not fully reflect the diversity and complexity of patients encountered in routine clinical practice. This imbalance creates a fundamental challenge for the field: can researchers be confident that new diagnostic tools and treatment strategies will perform consistently across the diverse populations seen in everyday clinical practice?

At AAIC 2026, this question took center stage during the Beckman Coulter Diagnostics and Danaher-sponsored symposium, Improving Real World Representation in Alzheimer’s Disease Clinical Research and Treatment, where six leading AD researchers in epidemiology, biomarker science, population health, and clinical research discussed why representation matters and what steps are needed to close persistent gaps in AD research. The panel explored topics ranging from accelerating clinical trials through blood-based biomarker screening to engaging underrepresented communities and building trust in research, as well as examining how plasma biomarkers may support broader participation and more equitable access to future diagnostic and treatment pathways.

The challenge extends beyond fairness and inclusion. Representative research is essential for scientific rigor. Blood-based biomarkers are increasingly being evaluated as scalable tools for detecting AD pathology, supporting biological staging, and improving access to precision medicine; however, if these biomarkers are primarily validated in populations that do not reflect the diversity of real-world patients, uncertainty will remain regarding how they will perform across different racial, ethnic, socioeconomic, and geographic groups.⁵

Technology alone will not solve the representation gap. Sustainable progress depends on meaningful community engagement, culturally relevant outreach, and partnerships based upon the trust, communication, and mutual respect foundational to medical progress.⁶ Increasing participation depends on building trust, improving education about AD and biomarker testing, and developing research programs that address community-specific needs and concerns. The symposium highlighted clinician education, community outreach, and real-world evidence generation as important components of a more inclusive research ecosystem.

Of course, increasing representation requires more than simply reducing logistical barriers. Blood-based biomarkers offer a potential pathway to address some of these challenges. Unlike PET imaging or lumbar puncture procedures, blood tests can be collected in a much broader range of healthcare settings, including community clinics and primary care practices. Because blood collection is already integrated into routine healthcare, biomarker testing may reduce logistical barriers that have historically limited participation in both research studies and future diagnostic pathways.

As blood-based biomarkers continue to mature and move closer to clinical implementation, they have the potential to support not only earlier and more scalable detection of AD, but also a more inclusive future for research and care. Ensuring that advances in biomarker research are validated across diverse populations—benefitting patient populations regardless of race, ethnicity, and potential comorbidities—is essential for generating confidence in their performance and for helping future advances benefit patients across all communities.

Moving forward, representation must be treated as a core scientific requirement rather than a secondary objective. As blood-based biomarkers continue to reduce barriers associated with traditional diagnostic approaches, they may help expand access to clinical research and future care pathways, ensuring that advances in AD diagnosis and treatment are informed by data that more closely reflect the populations most affected by the disease.