The state of Alzheimer's disease in Mexico: current challenges and directions for diagnosis and treatment.

Abstract

Alzheimer's disease (AD) is a major public health challenge in Mexico, with cases expected to rise significantly by 2050. For years, AD lacked major medical advances, but the emergence of plasma biomarkers and disease-modifying therapies has shifted the paradigm from symptomatic treatment to altering disease progression. While these advances are promising, they present substantial challenges for developing countries such as Mexico. The availability and interpretation of new biomarkers must be carefully managed, ensuring their use only in individuals with cognitive impairment rather than for asymptomatic screening. Furthermore, the presence of core biomarkers such as phosphorylated tau 217 in asymptomatic individuals should be considered, indicating "at-risk" status rather than biological AD. Although plasma biomarkers offer new opportunities, cerebrospinal fluid remains the only validated tool in Mexico for confirming amyloid pathology. In addition, two disease-modifying therapies are now approved in Mexico, but defining appropriate candidates, balancing potential benefits against risks, and monitoring treatment response remain significant challenges, especially in the absence of amyloid positron emission tomography imaging. Addressing these issues is critical to ensuring that new diagnostic and therapeutic strategies are effectively and equitably integrated into Mexico's healthcare system. Accordingly, there is an urgent need for the development of public policies and diagnostic infrastructure to ensure the safe, affordable, and sustainable implementation of these advances in countries such as Mexico.