To mark World Alzheimer’s Day, our neurosurgeon Dr. Emilio Ayats was interviewed on RTVE’s Canal 24h to discuss the current state of research, early diagnosis, and prevention of this disease, which already affects nearly one million people in Spain and could double its incidence by mid-century.
As Dr. Ayats explained in the interview, the challenge for the next decade is not so much to cure Alzheimer’s as to ensure it does not develop. And that race depends, to a large extent, on the ability to detect it long before the first symptoms appear.
Blood Biomarkers: Advancing Diagnosis by up to 20 Years
Pathological changes in the brain begin long before the first lapses in memory. Until now, confirming them required imaging tests (such as beta-amyloid detection) or lumbar punctures. Today, high-sensitivity techniques like NULISA allow for the analysis of up to 120 biomarkers in a simple blood test, without resorting to invasive procedures.
Among them, p-Tau217 stands out particularly; it is already available in specific blood tests and is capable of detecting neurodegenerative changes 10, 15, or even 20 years before cognitive impairment appears. In the words of Dr. Ayats, it is the gold standard biomarker of the moment.
Beyond Amyloid Plaque: Inflammation, Vascularization, and Mitochondria
Traditional research has focused on beta-amyloid protein and Tau protein, both involved in the advanced stages of the disease. However, there is growing evidence that the origin lies earlier: in a neurovascular component, in chronic low-grade inflammation, in the loss of mitochondrial function, and in the reduction of neuronal plasticity.
In this line, Dr. Emilio Ayats leads a research protocol that combines near-infrared spectroscopy—a non-invasive technique capable of assessing neuroactivation and vascularization status in real-time across 54 brain areas—with the study of the role of hyperbaric oxygen therapy on neuroinflammation and cerebral neovascularization. This is a developing line of research, and as such, its results are yet to be confirmed.
Monoclonal Antibodies: A Real Advance, with Important Nuances
Monoclonal antibodies against beta-amyloid are already approved and in use, but Dr. Ayats calls for caution rather than unmitigated optimism, for several reasons:
- They act on the final phase of the disease, and the relationship between amyloid plaque reduction and cognitive improvement is not direct.
- They are intravenous treatments, administered in a hospital setting, lasting between 12 and 18 months, and are high in cost.
- They require a prior genetic study: individuals with the double APOE4 allele—associated with a higher risk of Alzheimer’s—also present a higher risk of cerebral hemorrhage with this type of treatment.
They are, therefore, not suitable for all patients: their indication requires an individualized, rigorous, and evidence-based assessment.
Dementia Is Not Synonymous with Alzheimer’s
An important nuance emphasized by Dr. Emilio Ayats: not all dementia is Alzheimer’s. Dementia is a clinical syndrome of cognitive impairment with multiple possible causes—depression in the elderly, hypothyroidism, or other metabolic alterations can simulate a case of dementia without being one. Hence the importance of a differential diagnosis made by a specialist.
Five Scientifically Backed Habits to Care for the Brain
While research progresses, Dr. Ayats highlighted five prevention factors accessible to anyone:
- Cardiovascular health. Lo que es bueno para el corazón lo es también para el cerebro desde el punto de vista vascular.
- Cognitive reserve. Cuanto mayor es, menos evidente resulta el deterioro cuando aparece.
- Physical exercise. El músculo produce BDNF (factor neurotrófico derivado del cerebro), un modulador clave de la plasticidad cerebral.
- Deep sleep (non-REM). Durante estas fases, las células cerebrales reducen su volumen, lo que amplía hasta un 60% el espacio intersticial y facilita la eliminación de productos tóxicos.
- Hearing health. Una pérdida de audición moderada o severa multiplica hasta por 8-10 el riesgo de Alzheimer.
Cerebral Vascular Prevention: The Great Pending Challenge
Just as cardiovascular prevention is now established in the general consciousness, Dr. Emilio Ayats argues that we must incorporate cerebral vascular prevention in the same way. The five habits above are an accessible starting point, backed by evidence, while research into biomarkers and neuroinflammation continues to advance toward the ultimate goal: not curing Alzheimer’s, but preventing it from appearing.
Source: Interview with Dr. Emilio Ayats, Canal 24h (RTVE), World Alzheimer’s Day, September 21, 2026
