At-Home Alzheimer’s Tests Are Here

How DTC Alzheimer’s testing works

Direct-to-consumer companies vary in what they offer, how they operate and how much they charge. But most follow a similar process: After a customer signs on, they take an online cognitive assessment and fill out a questionnaire regarding their medical history. Blood is drawn at a participating lab or by a phlebotomist who comes to the home. No prescription is needed from their own doctor.

Most of the services use the p-tau217 biomarker, along with other tools to assess the risk for Alzheimer’s and the build-up of amyloid in the brain.  In addition to other biomarkers associated with diseases that cause dementia, some also test for apolipoprotein (APOE) gene variants, including APOE4, which is associated with a higher risk for AD. The companies avoid offering a definitive Alzheimer’s “diagnosis” but rather describe the risk for getting the disease.

A few companies, like Function Health,  offer 100+ biomarker lab tests. That company’s website states it aims to “empower you to live 100 healthy years." P-tau217, the APOE gene test and other amyloid biomarkers are add-ons not included in the $365 membership. About every six months about 60 tests are repeated. Function’s co-founder and chief medical officer is bestselling wellness author Dr. Mark Hyman.

Getting test results can take a few days or weeks. The companies say they have trained clinicians who review the tests. In most cases, customers get their results via an online portal along with a detailed report on the findings. But if the results reveal a concerning level of amyloid in the blood sample, which indicates a risk for Alzheimer’s, the companies offer consultations with trained practitioners (could be a certified wellness coach or a neurologist) and referrals to specialists. Those whose testing comes back normal can access various materials on how to avoid dementia and make healthful lifestyle choices.

Apollo Health’s Brainscan charges $799 for biomarker testing for p-tau217, GFAP (glial fibrillary acidic protein, found in the nervous system of people with neurodegenerative diseases), and Nfl (elevated levels of neurofilament light proteins are associated with Alzheimer’s and other cognitive diseases). Customers receive a testing kit that contains everything needed to have blood drawn within 4 to 6 days at one of a national network of blood draw locations.

If test results show signs of amyloid in the brain outside the normal range, a health coach — one of Apollo’s small staff of contracted certified wellness coaches — contacts the customer to review the results and offer guidance for the next steps they should take.

The major thrust of Brainscan, says Apollo chief science officer Dr. Dale Bredesen, is to find out if you have a risk of Alzheimer’s years before symptoms emerge so you can aggressively try to stave it off or, he claims, even reverse cognitive decline. (Although Bredesen offers a protocol for reversing Alzheimer’s, it has been widely refuted by the medical establishment and Alzheimer’s experts.) Bredesen’s research has been presented only in limited case studies rather than randomized clinical trials.

Another company, Neurogen Biomarking, which is still in test mode, offers a “personalized brain health action plan” to support the early detection of dementia due to Alzheimer’s. A board-certified neurologist reviews test results, and customers can ask questions on a virtual visit. They also fill out a short cognitive assessment online. A customer who is low risk receives educational materials about Alzheimer’s and dementia. More serious results are referred to “a neurologist, who will review your results and advise on next steps.”

What dementia doctors say

While at-home Alzheimer’s testing may have consumer appeal, it can open up a Pandora’s box of issues for customers who may actually have Alzheimer’s, as well as those who sign on out of curiosity, anxiety or to get an idea if they might get the disease down the road.

One of the major concerns is the accuracy of the results. The accuracy rate in a clinical setting hovers around 90 percent. In the at-home setting, however, the accuracy is not known, meaning the prevalence of false positives and false negatives is uncertain. This means the finding that you do (or do not) have an Alzheimer’s biomarker may be an error.

Another concern is the test results are not bifurcated into the usual two (positive or negative) but three categories of results: “positive” meaning the pathology is present, “negative” meaning it is not present, and – for as many as 10 to 20 percent of tests done in a clinical setting – an “indeterminate” result, which requires additional testing and evaluation. The likelihood of an indeterminate result in the at-home setting is, like accuracy, unknown.

Another concern is that a person may also have large amounts of amyloid tangles but show no outward symptoms of disease.

“Having amyloid in the brain doesn’t always equal Alzheimer’s disease,” says Dr. Zaldy Tan, a memory and aging specialist at the Cedars-Sinai Medical Center in Los Angeles.

“It’s like having cholesterol deposits or a narrowing of an artery. It doesn’t mean you have a heart attack. We now know that amyloid sits in the brain for 10 to 20 years, so if we’re checking biomarkers on someone who is 80 they may not get the disease unless they live to 100. It may not matter.”

Test results may indicate a risk for Alzheimer’s, but that finding may actually be due to a vitamin deficiency, certain medications or multiple other conditions that can mimic dementia.

Moreover, sitting down with a patient and discussing test results and communicating what may be a life-changing diagnosis requires both medical and psychological skills.

“It can be terrifying to learn your memory problems are not due to aging but to a chronic, progressive, uniformly fatal disease that robs us of the very qualities that make us human,” says Dr. Howard Fillit, co-founder and chief science officer of the Alzheimer’s Drug Discovery Foundation.

Dr. Sharon Brangman, chair of geriatric medicine at SUNY Upstate Medical University and a trustee at the McKnight Brain Research Foundation, says this interaction between patient and physician is essential for an accurate diagnosis of Alzheimer’s.

“The most important piece of an evaluation is the story that someone tells about their memory loss,” says Brangman. “When problems began. Is it affecting day-to-day function? The other medications someone may be taking. It’s not like a cholesterol test where you know if it’s abnormal if the test is high. The (p-tau217) test may be positive in someone who doesn’t have Alzheimer’s or negative in someone who does. Many people test positive and never develop the disease — almost 16 percent of 60 year olds  and 23 percent of 70-year-old adults, according to a 2015 Dutch study.

“My concern is that people who are curious will do this test and it will cause stress and anxiety that is unnecessary,” she adds.

Meanwhile, DTC companies welcome anyone 18 and older for testing, whether they are experiencing symptoms of cognitive decline or not. Most Alzheimer’s professionals adhere to 2025 clinical guidelines from the Alzheimer’s Association, which recommend that only people with symptoms be tested.  The reason: “There is no proven medical treatment for AD before people have symptoms. Period,” says Dr. Andrew Budson, associate director of Boston University’s Alzheimer’s Disease Research Center.

Privacy in an era of data sharing

Biomarker testing can be a minefield when it comes to privacy issues. A test result may not be accurate, but it can leave people extremely vulnerable. They may be denied long-term care or life insurance or be discriminated against on the job.

If younger asymptomatic people undergo at-home testing out of curiosity, the results could potentially impact their professional life. According to attorney Jalayne Arias, a bioethicist and associate professor of Health Policy and Behavioral Sciences at Georgia State University, commercial companies don’t fall under the same legal guidelines as health care companies when it comes to sharing personal data.

“I am still in proceed-with-caution mode,” says Arias, whose expertise is discrimination from biomarker testing.

All the more reason why individuals should consider numerous factors before signing up for direct-to-consumer Alzheimer’s testing. With so many as-of-yet unresolved issues, the jury is still out. An Alzheimer’s diagnosis can change someone’s life in myriad ways that are hard to prepare for. While the at-home testing model has understandable appeal — easy and accessible, like online shopping — and medical experts say there may be a place in the future for direct-to-consumer Alzheimer’s testing, for now, their message to consumers is: Proceed with caution.