I am 77 years old, and both my mother and grandmother had advanced Alzheimer's disease at my age. I am not as sharp as I was 20+ years ago, but my overall brain function seems to be OK. I would like to have this test done. By the way, I just ordered your book!
As far as I know, ptau217 is not currently covered by insurance (please correct me):
Medicare does not reimburse pTau-217 blood testing in routine practice. There is no coverage for asymptomatic individuals or “screening” purposes, even if they have a family history or APOE4 genetic risk . Only patients with clear cognitive symptoms being evaluated for AD might get related tests covered – and then Medicare favors CSF or PET biomarkers over blood tests.
Most private insurers mirror Medicare’s cautious stance. Major payers – including Aetna, Cigna, UnitedHealthcare, and Anthem Blue Cross/Blue Shield – currently label pTau-217 blood tests as experimental and do not cover them for AD diagnosis or risk screening
Note that the actual cost of the test a few hundred dollars - definitely not ~$1.2k. The consumer options I mentioned in my other comment illustrate this.
My grandmother and 5 of her siblings had AD and my dad is headed down the same path, albeit at late age (87), so I am definitely interested in this test. I wonder if there is benefit to actually “knowing”? Is it possible to just do all the interventions without having the knowledge burden (and potential insurance complications). Or is there beneficial advanced tracking that only comes with testing? I’ve pre purchased your book Dr Topol so hopefully there will
Great questions. If you are already doing everything in the lifestyle plus factors, then knowing at the moment might not be as helpful. But most people aren't optimum there. Further, if the GLP-1 drugs click for Alzheimer's (2 big trials to read out later this year in non-obese people) that will change things, along with other drugs under study.
I so enjoy all of your incredibly informative and interesting posts Eric. I am a non-medical person who just likes to learn new things… You provide that in spades and are great relief from all of the horrific political and social news that I’m getting in my email .Thank you so much. I am a subscriber.
Thank you for this excellent, highly-informative article, Dr. Topol. A question, if I may: Your view is that the test should _not_ be done _routinely_ in people who are cognitively intact, but you also mention that the test can play an important role in identifying people who are at high-risk. Would I be correct in thinking that you _would_ endorse having a p-Tau217 test done if the person in question were cognitively intact but had, for example, a family history of Alzheimer's in both a parent and a grandparent? Or would you want to determine the presence of more risk factors than that family history before recommending this particular test? Thank you for any thoughts that you may be able to share on this!
Thank you so much for bringing the news! While much of this sails over my head, I am nonetheless grateful for your continuing thoughtful and knowledgeable reporting on medical advances. I particularly appreciated this, which is so tremendously hopeful in addressing this devastating disease: “The p-Tau217 biomarker is one of the most exciting advances in neurology for decades, giving us a new opportunity to accurately predict and potentially prevent (or at least substantially delay) MCI and Alzheimer’s. That it rises so early in the course of the disease—which incubates over 20 years—gives us a long runway of opportunity to intervene, be it with lifestyle factors or drugs.” I also appreciated your noting that over-testing is problematic. I have a friend who, while cognitively intact but worried, was tested for dementia (I think this was pre- the testing you describe). She was devastated to learn she might succumb, and of course there was no remedy. She is resilient and found her way forward to continue to enjoy her life, but she should never have been put through this.
Thanks, Susan. The exciting part of all this the potential for reversibility as we've sen with exercise and some of the f=drugs that are used today, with more coming. It gives me considerable hope and for your friend as well.
I have taken several of these p-tau217 blood tests to track my levels over time as I learned from the AHEAD3-45 trial in 2019 that my PET showed elevated AB. My question is what was your source for the levels in your graphs? Right now it can be like comparing apples to oranges between providers as no one has been FDA final-approved although Labcorp & Quest seem to be fairly comparable. As an E3/E4 with a dad who passed from AD, I believe blood biomarkers like p-Tau217 are a life changer that will drive the field forward with more & better solutions for people like me. I've already been able to reduce my levels slightly through lifestyle changes :)
Why are you not recommending the test to asymptomatic people. Is the rate of false positives too high to recommend testing in a low prevalence population?
The p-tau test is a game changer for preventing Alzheimer's. Thank you for writing this article. I found your discussion of exercise reducing p-Tau levels to be very interesting. Thank you for the links to the recent publications in this regard. Here is another lifestyle choice that will reduce p-Tau: reducing your body burden of aluminum by drinking silica rich mineral water and eliminating sources of aluminum you are exposed to. Aluminum inhibits two enzymes in the body at extremely low levels to cause high levels of p-Tau 181 and 217. Occupational data supports this ( I will post reference). Exercise reduces p-Tau levels as aluminum is excreted through sweat. For anyone who wants to learn more about aluminum, Alzheimer's and silica water check out my substack or the writings of Dennis N Crouse. Lu, X., et al.; Cognitive disorders and tau-protein expression among retired aluminum smelting workers; JOEM; Feb.; 56(2):155-60 (2014) https://pubmed.ncbi.nlm.nih.gov/24451610/
- Function Health. Pricing is TBD AFAIK (not seeing it available yet as a member), but would be on-top of $499 annual membership (https://www.functionhealth.com)
Note: We at BetterBrain believe it's irresponsible to offer standalone pTau-217 tests because the results can be challenging to interpret. If you have elevated levels -- now what? Instead, its an add-on to our Check-up which includes 53 blood biomarkers (ApoB, homocysteine, etc.), extensive lifestyle questionnaire, and cognitive testing, and a 75 minute consultation with a brain health expert. That way, if you have elevated (or even moderate) levels, you have a clear plan of action to bring it down.
Eric, I'm 82 and this caught my eye: "There are some limitations of p-Tau217, such as it begins to go lower at the late stage of the disease, and it may not be as useful in people age 80 plus." Is there a way for me to dig deeper on why t-Tau isn't as useful for people over 80?
I am 77, a retired physician, have a family history of dementia, most notably my mother, who had an 11 year course of AD before she died at age 96. I have been noting mild subjective cognitive decline symptoms, mainly memory challenges for several years. This is all complicated by my having adult ADHD, which includes a number of challenges with memory, attention, etc. I recently had the P-Tau 217 test done and the result was elevated (1.09 ng/l) and am wondering what the best approach to lowering the Tau level. I exercise regularly (yoga and strength training), eat a predominantly plant based keto-flex-ish diet (much of the vegetables coming from our garden, but occasionally complicated by snacking on higher carb treats), drink only moderately, get reasonably good sleep, and have reasonably good social relationships.
Any suggestions?
In addition, I recently read about an intriguing new line of research by Samuel Stupp's lab at Northwestern, looking into the use of trehalose treated peptide amphiphiles, which become destabilized nanofibers, which then can latch on to misfolded proteins (e.g., amyloid beta), integrate them into their nanofibers, stop them from clumping together, and then degrade harmlessly in the body. This sounds like a very promising treatment approach.
I am 77 years old, and both my mother and grandmother had advanced Alzheimer's disease at my age. I am not as sharp as I was 20+ years ago, but my overall brain function seems to be OK. I would like to have this test done. By the way, I just ordered your book!
It's available through Quest and LabCorp, among other labs. Let me know how it turns out. Thanks!
My PCP thinks it will cost over $1,200 with no insurance coverage. Do you know if that is true?
As far as I know, ptau217 is not currently covered by insurance (please correct me):
Medicare does not reimburse pTau-217 blood testing in routine practice. There is no coverage for asymptomatic individuals or “screening” purposes, even if they have a family history or APOE4 genetic risk . Only patients with clear cognitive symptoms being evaluated for AD might get related tests covered – and then Medicare favors CSF or PET biomarkers over blood tests.
Most private insurers mirror Medicare’s cautious stance. Major payers – including Aetna, Cigna, UnitedHealthcare, and Anthem Blue Cross/Blue Shield – currently label pTau-217 blood tests as experimental and do not cover them for AD diagnosis or risk screening
Note that the actual cost of the test a few hundred dollars - definitely not ~$1.2k. The consumer options I mentioned in my other comment illustrate this.
My grandmother and 5 of her siblings had AD and my dad is headed down the same path, albeit at late age (87), so I am definitely interested in this test. I wonder if there is benefit to actually “knowing”? Is it possible to just do all the interventions without having the knowledge burden (and potential insurance complications). Or is there beneficial advanced tracking that only comes with testing? I’ve pre purchased your book Dr Topol so hopefully there will
Be more guidance!
Great questions. If you are already doing everything in the lifestyle plus factors, then knowing at the moment might not be as helpful. But most people aren't optimum there. Further, if the GLP-1 drugs click for Alzheimer's (2 big trials to read out later this year in non-obese people) that will change things, along with other drugs under study.
Already on Mounjaro for weight loss!
I so enjoy all of your incredibly informative and interesting posts Eric. I am a non-medical person who just likes to learn new things… You provide that in spades and are great relief from all of the horrific political and social news that I’m getting in my email .Thank you so much. I am a subscriber.
I'm so appreciative of your feedback, Kathryn. Thanks!!
Thank you for this excellent, highly-informative article, Dr. Topol. A question, if I may: Your view is that the test should _not_ be done _routinely_ in people who are cognitively intact, but you also mention that the test can play an important role in identifying people who are at high-risk. Would I be correct in thinking that you _would_ endorse having a p-Tau217 test done if the person in question were cognitively intact but had, for example, a family history of Alzheimer's in both a parent and a grandparent? Or would you want to determine the presence of more risk factors than that family history before recommending this particular test? Thank you for any thoughts that you may be able to share on this!
yes, that would make the pre-test probability higher and the p-Tau217 worthwhile
Thank you very much, Dr. Topol. I look forward to reading the book!
Thank you so much for bringing the news! While much of this sails over my head, I am nonetheless grateful for your continuing thoughtful and knowledgeable reporting on medical advances. I particularly appreciated this, which is so tremendously hopeful in addressing this devastating disease: “The p-Tau217 biomarker is one of the most exciting advances in neurology for decades, giving us a new opportunity to accurately predict and potentially prevent (or at least substantially delay) MCI and Alzheimer’s. That it rises so early in the course of the disease—which incubates over 20 years—gives us a long runway of opportunity to intervene, be it with lifestyle factors or drugs.” I also appreciated your noting that over-testing is problematic. I have a friend who, while cognitively intact but worried, was tested for dementia (I think this was pre- the testing you describe). She was devastated to learn she might succumb, and of course there was no remedy. She is resilient and found her way forward to continue to enjoy her life, but she should never have been put through this.
Thanks, Susan. The exciting part of all this the potential for reversibility as we've sen with exercise and some of the f=drugs that are used today, with more coming. It gives me considerable hope and for your friend as well.
I have taken several of these p-tau217 blood tests to track my levels over time as I learned from the AHEAD3-45 trial in 2019 that my PET showed elevated AB. My question is what was your source for the levels in your graphs? Right now it can be like comparing apples to oranges between providers as no one has been FDA final-approved although Labcorp & Quest seem to be fairly comparable. As an E3/E4 with a dad who passed from AD, I believe blood biomarkers like p-Tau217 are a life changer that will drive the field forward with more & better solutions for people like me. I've already been able to reduce my levels slightly through lifestyle changes :)
Why are you not recommending the test to asymptomatic people. Is the rate of false positives too high to recommend testing in a low prevalence population?
Asymptomatic yes, but only those who have increased risk such as family history or APOE4 allele, etc
The p-tau test is a game changer for preventing Alzheimer's. Thank you for writing this article. I found your discussion of exercise reducing p-Tau levels to be very interesting. Thank you for the links to the recent publications in this regard. Here is another lifestyle choice that will reduce p-Tau: reducing your body burden of aluminum by drinking silica rich mineral water and eliminating sources of aluminum you are exposed to. Aluminum inhibits two enzymes in the body at extremely low levels to cause high levels of p-Tau 181 and 217. Occupational data supports this ( I will post reference). Exercise reduces p-Tau levels as aluminum is excreted through sweat. For anyone who wants to learn more about aluminum, Alzheimer's and silica water check out my substack or the writings of Dennis N Crouse. Lu, X., et al.; Cognitive disorders and tau-protein expression among retired aluminum smelting workers; JOEM; Feb.; 56(2):155-60 (2014) https://pubmed.ncbi.nlm.nih.gov/24451610/
I wanted to answer the question on where consumers can get this test.
DISCLAIMER: I work for BetterBrain.
There are a few companies that make pTau217 testing available to consumers (i.e., w/o going through a doctor). In alphabetical order:
- Apollo Health BrainScan for $799 (https://www.apollohealthco.com/brainscan)
- BetterBrain. It's a $200 add-on to our Check-up for total of $599 (https://checkup.betterbrain.com)
- Function Health. Pricing is TBD AFAIK (not seeing it available yet as a member), but would be on-top of $499 annual membership (https://www.functionhealth.com)
Note: We at BetterBrain believe it's irresponsible to offer standalone pTau-217 tests because the results can be challenging to interpret. If you have elevated levels -- now what? Instead, its an add-on to our Check-up which includes 53 blood biomarkers (ApoB, homocysteine, etc.), extensive lifestyle questionnaire, and cognitive testing, and a 75 minute consultation with a brain health expert. That way, if you have elevated (or even moderate) levels, you have a clear plan of action to bring it down.
Great article, really like the clear graphs!
Another timely perspective published in Nature: https://www.nature.com/articles/d41586-025-01105-z
Good summary of AD diagnostic evolution and open questions for blood biomarker usage
Eric, I'm 82 and this caught my eye: "There are some limitations of p-Tau217, such as it begins to go lower at the late stage of the disease, and it may not be as useful in people age 80 plus." Is there a way for me to dig deeper on why t-Tau isn't as useful for people over 80?
I am 77, a retired physician, have a family history of dementia, most notably my mother, who had an 11 year course of AD before she died at age 96. I have been noting mild subjective cognitive decline symptoms, mainly memory challenges for several years. This is all complicated by my having adult ADHD, which includes a number of challenges with memory, attention, etc. I recently had the P-Tau 217 test done and the result was elevated (1.09 ng/l) and am wondering what the best approach to lowering the Tau level. I exercise regularly (yoga and strength training), eat a predominantly plant based keto-flex-ish diet (much of the vegetables coming from our garden, but occasionally complicated by snacking on higher carb treats), drink only moderately, get reasonably good sleep, and have reasonably good social relationships.
Any suggestions?
In addition, I recently read about an intriguing new line of research by Samuel Stupp's lab at Northwestern, looking into the use of trehalose treated peptide amphiphiles, which become destabilized nanofibers, which then can latch on to misfolded proteins (e.g., amyloid beta), integrate them into their nanofibers, stop them from clumping together, and then degrade harmlessly in the body. This sounds like a very promising treatment approach.
I have checked both Quest and Labcorp locally in San Diego and neither are offering the ptau 217 that I could discern.
This test is available with Function Health.
https://www.functionhealth.com/biomarker-categories/brain-health
They also test amyloid beta, apoe and a few other markers related to brain health and Alzheimer's.