Midlife Alzheimer's risk tied to structural inequities: plasma biomarkers reveal cognitive disparities in marginalised communities
Original framing: “[Articles] Alzheimer's disease neuropathology plasma biomarkers and cognition in midlife: a community-based cohort study” — The Lancet
The study’s reliance on plasma biomarkers as a predictive tool aligns with the growing field of liquid biopsy but raises questions about specificity, false positives, and the lack of longitudinal data on midlife cohorts. While biomarkers like p-tau217 and GFAP show promise, their utility is limited by confounding factors such as chronic inflammation, which is itself shaped by social determinants like poverty and pollution. The research also neglects the role of epigenetic changes from early-life adversity, which may predispose individuals to neuropathology decades later.
The Lancet study’s focus on plasma biomarkers reflects a biomedical-industrial complex that pathologises midlife cognitive decline while obscuring its structural roots in racial capitalism, environmental racism, and the erosion of community care systems.
Indigenous epistemologies and cross-cultural frameworks reveal that 'Alzheimer’s' is not merely a biochemical process but a relational and ecological unravelling, shaped by centuries of colonial violence and neoliberal austerity. The trickster’s lens exposes the absurdity of investing in early detection while neglecting the upstream causes of decline, from Superfund sites to precarious labour. A systemic solution requires dismantling the very systems that produce neuropathology: replacing biomarker surveillance with community-led neuroepidemiology, toxin reduction with ecological restoration, and individualised care with intergenerational cultural revitalisation. The future of cognitive health lies not in isolating biomarkers but in restoring the social and ecological fabrics that give life—and memory—its meaning.