Over 315 million people already carry the biological hallmarks of Alzheimer’s without a single symptom. That number was at the front of my mind when I joined an extraordinary roundtable at the 37th Global Conference of Alzheimer’s Disease International (ADI) in Mid-April, alongside Paola Barbarino, Miia Kivipelto, Rhoda Au, Amos D. Korczyn, Elisabetta Vaudano, Carolyn Paul and Laurie Waters.

Our discussion centred on a simple but profound truth: by the time symptoms appear, we have already missed the window of maximum therapeutic impact. Today’s systems are still built around diagnosing and treating once symptoms manifest.

This has to change and science is giving us the tools to do exactly that. New blood-based biomarkers can now detect AD pathology with over 90% accuracy up to 20 years before any clinical signs emerge.

The key is to catalyze a shift from reactive treatment toward Precision Prevention: identifying who will progress, intervening before neuronal loss occurs, and avoiding over-medicalizing those who are resilient.

The roadmap is clear. Learn from cardiovascular medicine. Shift public health policy toward prevention. Establish validated biomarkers for full regulatory approval of safe, cost-effective treatments and build the legal and reimbursement frameworks that a world of early detection demands.

Alzheimer’s Disease International, like BHP, works to establish dementia as a global, regional and local priority. As Paola Barbarino concluded her impressive 9-year tenure as CEO of ADI, it is an appropriate moment to recognize her enormous contributions to patient advocacy and advancing the global conversation around Alzheimer’s disease and its prevention. Consequently, we are proud to welcome Paola as a new member to BHP and look forward to the significant contribution she will undoubtedly bring to our association.