Neurology 2027

Advances in biomarkers, neuroimaging, and cognitive assessment have improved Alzheimer's disease identification but do not fully characterize its functional expression. This gap affects clinical interpretation, interdisciplinary communication, and individualized care planning.

Traditional staging terminology, including mild, moderate, and severe, summarizes broad disease progression but often obscures clinically meaningful differences in functional presentation. Interpretation and application of these designations may also vary between clinicians, introducing ambiguity into documentation, interdisciplinary communication, and continuity of care.

This keynote examines functional presentation as an essential dimension of Alzheimer's assessment, emphasizing the distinction between identifying disease and characterizing its expression. Discussion focuses on recognizing patterns of functional change, documenting retained and changing abilities, and interpreting longitudinal evidence to guide reassessment.

Families need more than a staging designation. They need to understand what it means for the person they know and what may come next. Greater functional precision enables clinicians to explain changes, identify emerging support needs, and provide individualized anticipatory guidance without assuming a predetermined trajectory.

The challenge is no longer simply how precisely we can identify Alzheimer's disease, but how precisely we can characterize its functional expression. When staging language fails to distinguish meaningful differences, clinical interpretation becomes less consistent, communication becomes less informative, and opportunities for individualized intervention may be missed. Advancing Alzheimer's care requires that functional precision become as central to clinical practice as diagnostic precision.

Lauren P. Brown is an author, educator, dementia care specialist, and founder of Alzheimer's Rewritten™, an initiative advancing precision in Alzheimer's clinical language, functional characterization, and individualized care. With a background in human behavior, counseling, education, and dementia care, her interdisciplinary work examines the relationship between disease biology, functional presentation, and clinical decision-making. She is the developer of the Interdisciplinary Alzheimer's Curriculum™ and the Alzheimer's Tiered Progression Matrix, frameworks designed to strengthen professional training, clinical communication, and person-centered care. Her work emphasizes translating clinical knowledge into meaningful, individualized support for people living with Alzheimer's disease and their families.