Penn researcher describes psychological and legal burden of preclinical Alzheimer's biomarker results

Jason Karlawish, a professor of medicine, medical ethics, health policy and neurology at the University of Pennsylvania's Perelman School of Medicine, published a column on Nov. 13, 2026, describing what it is like to learn that biomarker tests suggest a person may develop Alzheimer's. Karlawish, co-director of the Penn Memory Center, framed the piece as the second part of a series on living with preclinical Alzheimer's. He began by citing neurologist Robert Katzman's 1976 essay calling for Alzheimer's to be understood as a single disease that must be prevented.

The piece is expert commentary, not a clinical trial or observational study. The published excerpt identifies biomarker tests as the trigger for preclinical risk knowledge and notes psychological and legal challenges in the title. It invokes Katzman's historical framing that Alzheimer's should be prevented, not merely prolonged. Because the full text is subscriber-only, the article does not provide patient numbers, test accuracy estimates, or documented legal cases in the public excerpt.

The column sits at the intersection of diagnostic technology and patient autonomy. Biomarker tests can reveal Alzheimer's-related biology before memory loss appears, so a positive result is not a dementia diagnosis but a probability statement. That gap creates a new personal category: people who know they may be on a path toward impairment but do not yet meet clinical criteria for disease. The ethical question is how much such information should be offered when medical options are limited and the consequences of disclosure are not fully mapped.

The stakes are highest for adults who learn of preclinical Alzheimer's risk while still functioning well. They may need to decide how to use time, disclose results to family, revise legal documents and seek support before symptoms appear. For clinicians and health systems, the issue is whether biomarker testing can be paired with counseling, privacy protections and clear limits on how results are used. Because the piece is expert commentary, it cannot show how many people are harmed or which safeguards work; that would require observational studies and controlled trials of counseling and disclosure policies.