New biomarker-centric diagnostic frameworks for Alzheimer’s disease promise earlier detection but risk over-medicalising people who may never decline. Grasso, Santos-Santos and Clark contend that amyloid-β or phosphorylated-tau positivity in cognitively normal adults should be treated as an _elevated risk_ rather than a definitive diagnosis, and they show why cognitive reserve, sociocultural context and structural inequities must shape interpretation. They map out how risk-based, multi-factor models—built on racially representative data and paired with neuropsychology—can curb overdiagnosis, stigma and widening health gaps. This commentary gives clinicians and researchers an equity-driven roadmap for integrating biomarkers into precision-medicine Alzheimer’s care.
