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A study of 186 attendees at a brain health service in Monza, Italy, found that people reporting cognitive changes despite normal standard test performance often had modifiable dementia risk factors. Among participants with subjective cognitive decline, higher blood p-Tau217 was associated with early signs of neurodegeneration; about 60% of those who received results said they felt more motivated to make lifestyle changes.
A study of 186 people attending a brain health service in Monza, Italy, found that many people who noticed changes in their memory or thinking despite normal performance on standard tests had modifiable dementia risk factors. Researchers also reported that elevated blood levels of the Alzheimer’s-related biomarker p-Tau217 were linked to early signs of neurodegeneration in some participants with subjective cognitive decline, while about 60% of those given results said they felt more motivated to make lifestyle changes.
The study, published in Neurological Sciences, included 132 participants with subjective cognitive decline (SCD) among the 186 consecutive attendees assessed at the Monza service. SCD describes people who report changes in cognition but continue to perform normally on standard cognitive tests. Researchers compared the clinical, biological and imaging characteristics of attendees classified as having SCD, mild cognitive impairment, functional cognitive decline or being worried about their risk.
For SCD participants with available blood test results, the researchers classified p-Tau217 levels of 0.15 picograms per milliliter or higher as above the study’s threshold and lower results as below it. The report says those with above-threshold results showed signs associated with neurodegeneration. This finding concerns a subgroup and does not mean that every person with SCD has Alzheimer’s disease or will develop dementia.
At a follow-up visit, participants received their p-Tau217 and APOE genotype results, along with an estimate of dementia risk and recommendations for preventive measures. A week later, participants completed online questionnaires about the disclosure. About 60% of those who received their results reported increased motivation to make lifestyle changes, according to the report. The study assessed self-reported motivation, not whether participants later changed their behavior or whether those changes reduced dementia risk.
What Risk Disclosure May Change
The findings speak to a gap between how a person experiences their memory and what a standard cognitive test detects. People with SCD may have concerns worth discussing even when their test results do not show impairment. A broader assessment can examine possible contributing risks and, in some settings, biomarkers, rather than treating a normal test as the whole picture.
The reported response to disclosure also suggests that carefully explaining individual risk information may encourage some people to consider prevention. But the study does not establish that biomarker disclosure produces lasting lifestyle changes, prevents dementia or improves health outcomes. Its results are an early indication from one service, not evidence that the same approach will work for everyone.
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How Brain Health Services Assess Risk
Brain health services differ from conventional memory clinics, which focus mainly on diagnosing and treating cognitive disorders. The Monza service was designed around risk assessment and reduction. Depending on the person’s assessment, its evaluation can include cognitive screening, blood biomarkers such as p-Tau217 and GFAP, APOE genotyping and brain imaging. Attendees found to have mild cognitive impairment can be referred to a memory clinic.
Clinical practice around biomarker testing in people without clear cognitive impairment remains debated. The source report says the Alzheimer’s Association’s 2024 criteria allow biological definitions of Alzheimer’s disease using biomarkers when the tests perform adequately, but its workgroup recommends against diagnostic biomarker testing in cognitively unimpaired people outside observational or therapeutic research. The International Working Group generally describes biomarker-positive, cognitively unimpaired people as being at risk rather than as having Alzheimer’s disease, while allowing non-diagnostic testing pathways for people with SCD to estimate and communicate risk.
The study also refers to a Lancet Commission estimate that addressing 14 modifiable risk factors could potentially prevent or delay up to 45% of dementia cases. That estimate is a population-level finding; it is not an individual prediction and does not mean that a particular person can avoid dementia by changing lifestyle factors.
“About 60% of participants who underwent disclosure reported greater motivation for lifestyle changes.”
— The study authors, as summarized by News-Medical
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Limits of the Monza Findings
The study was an exploratory analysis of 186 attendees at a single service, including 132 with SCD. The source report cautions that the group comparisons are limited by sample size, so they should not be treated as definitive profiles of everyone with SCD, mild cognitive impairment or other concerns.
The reported 60% figure reflects self-reported motivation after disclosure. The available report does not establish how many participants followed through with lifestyle changes, whether any changes lasted, or whether they altered later cognitive outcomes. It also does not provide enough detail to determine how representative the service attendees were of people with memory concerns in the wider population.
Biomarker results and risk estimates do not settle whether a person has, or will develop, dementia. The meaning of a p-Tau217 result depends on the test and threshold used and on the person’s wider clinical picture. The study does not show that biomarker testing or disclosure should be used routinely for all people whose cognitive tests are normal.
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Follow-Up on Behavior and Outcomes
The immediate next step is to determine whether the motivation reported after disclosure translates into measurable, sustained changes in risk-related behaviors. The source report describes a questionnaire one week after results were shared but does not report longer-term follow-up or clinical outcomes. Longer observation would be needed to show whether the approach changes behavior or affects cognitive health.
For now, the findings add real-world evidence to discussion about how brain health services can assess and communicate risk for people with subjective concerns. Decisions about biomarker testing and the interpretation of results remain dependent on clinical guidance and individual circumstances; the study does not provide a basis for diagnosing dementia from a blood result alone.
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Key Questions
What is subjective cognitive decline?
Subjective cognitive decline means a person notices changes in memory or thinking while still performing normally on standard cognitive tests. It can have different causes and does not by itself establish a diagnosis of dementia.
What did the study find about p-Tau217?
Among SCD participants with available blood tests, the researchers classified results at or above 0.15 pg/mL as above the study’s threshold. The report linked elevated results to early signs of neurodegeneration in some participants; it does not say that the result alone diagnoses Alzheimer’s disease.
Did receiving biomarker results lead people to change their lifestyle?
About 60% reported greater motivation to make lifestyle changes after receiving their results and risk estimates. The study measured self-reported motivation one week later, not completed or sustained behavior changes.
Does a normal cognitive test rule out future dementia?
The study shows that reported cognitive concerns and standard test performance do not always tell the same story. It does not establish an individual’s future risk; SCD can have varied causes, and assessment depends on clinical and personal factors.
Should everyone with memory concerns get a blood biomarker test?
No such recommendation follows from this study. Guidance on testing cognitively unimpaired people remains debated, and the report describes restrictions and non-diagnostic approaches. People with concerns should discuss assessment options with a qualified health professional.
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