Robert Egge on Blood Tests, Medicare, and the Push for Earlier Diagnosis
Robert Egge estimates that more than four million Americans have mild cognitive impairment (MCI) due to Alzheimer’s disease, yet only about one in 10 has been diagnosed. For everyone else, the window when today’s treatments work best is quietly closing.
As chief public policy officer of the Alzheimer’s Association, Robert has spent more than 15 years pushing Congress to invest in Alzheimer’s research. Now he’s focused on a new challenge: making sure breakthroughs reach people early enough to make a difference in their care and quality of life.
In this episode, Robert shares why early diagnosis is vital, how blood tests could help primary care doctors catch Alzheimer’s sooner, and what it will take to bring Alzheimer’s screening into Medicare.
In This Episode:
Your Host: Emily Kaplan
Our Guest: Robert Egge, Chief Public Policy Officer of the Alzheimer’s Association and President of the Alzheimer’s Impact Movement (AIM)
This Episode Explores:
- Why does an Alzheimer’s diagnosis often come too late?
- How can blood tests help primary care doctors diagnose Alzheimer’s?
- Why doesn’t Medicare currently cover Alzheimer’s screening?
- What is the ASAP Act?
- Which lifestyle changes support brain health?
What Are the Barriers to an Early Alzheimer’s Diagnosis?
Robert calls diagnosis one of the “most fundamental disappointments” for families facing dementia. Many people hear that their symptoms are “nothing,” receive a diagnosis for the wrong type of dementia, or wait years for accurate answers.
Part of the problem lies in the typical exam room. A primary care visit doesn’t usually allow enough time for the careful, nuanced evaluation that cognitive symptoms require. Patients may also hesitate to bring up memory concerns, given the stigma that still surrounds the disease. [link last 6 words to Guy Benson episode page once live: https://aheadofalzheimers.org/guy-benson-breaking-silence-alzheimers/]
Specialists can’t fill the gap alone. Some states have hardly any neurologists, with only a few specializing in dementia. For many people, Robert says, long waits mean they “can’t get to one and kind of give up.”
How Could Blood Tests Change Alzheimer’s Care?
The FDA has now cleared four Alzheimer’s blood tests, including the first p-tau217 test authorized for use in primary care.
These tests can help primary care doctors diagnose Alzheimer’s much more accurately, and for patients, an earlier diagnosis means the chance to make their own choices about treatment, lifestyle, and planning.
“There are tremendous reasons why earlier is always better,” Robert says.
Why Doesn’t Medicare Cover Alzheimer’s Screening Yet?
Another obstacle impacting earlier detection is current Medicare policy. When Congress created Medicare in 1965, lawmakers focused on treating acute illness, not preventing disease. That means Medicare generally can’t cover a new screening test for people without symptoms unless Congress authorizes it.
The bipartisan Alzheimer’s Screening and Prevention (ASAP) Act aims to change that. This bill would give Medicare the authority to cover FDA-approved blood-based screening tests for Alzheimer’s and other dementia. Robert calls this “our mammogram moment,” a chance to fundamentally change how the country detects dementia.
Watch the episode to learn more about the inspiration behind Robert Egge’s career in Alzheimer’s policy, hear what the U.S. POINTER study found about lifestyle and brain health, and see how you can show your support for the ASAP Act.
FAQs About Alzheimer’s Screening, Blood Tests, and Medicare
What is mild cognitive impairment (MCI)?
Mild cognitive impairment causes changes in memory or thinking that others may notice but that do not interfere yet with daily life. Not everyone with MCI develops Alzheimer’s. When Alzheimer’s causes MCI, it’s the stage when current treatments work best, which makes early diagnosis so important.
What is the difference between Alzheimer’s screening and diagnosis?
Diagnosis happens after symptoms appear, when a doctor works to identify the cause. Screening looks for signs of disease in people who don’t yet have symptoms. Today’s FDA-cleared Alzheimer’s blood tests are for adults with symptoms. The ASAP Act would open a path for Medicare to cover screening tests once the FDA approves them.
How accurate are Alzheimer’s blood tests?
In a 2024 Swedish study, a blood test identified Alzheimer’s with about 91% accuracy. Primary care doctors working without biomarker tests reached 61%, and dementia specialists reached 73%. Blood tests work best alongside a full medical evaluation. Learn more from Dr. Jeff Burns.
What is the ASAP Act?
The Alzheimer’s Screening and Prevention (ASAP) Act is bipartisan legislation that would allow Medicare to cover FDA-approved blood-based screening tests for Alzheimer’s and other dementia. Visit the Alzheimer’s Impact Movement to see the bill’s status and contact your members of Congress.
What role can primary care doctors play in Alzheimer’s care?
Most people with early memory concerns see a primary care doctor first. New blood tests, digital cognitive assessments, and virtual training programs like Project ECHO can help primary care doctors identify Alzheimer’s earlier. Hear how John and Grace Showalter built a primary care clinic focused on dementia.
Can lifestyle changes lower the risk of dementia?
Research says yes. The 2024 Lancet Commission estimates that nearly half of dementia cases could be prevented or delayed by addressing 14 risk factors. The U.S. POINTER study found that a structured program of exercise, healthy eating, cognitive and social engagement, and health monitoring helped protect memory and thinking.