Blood‐based biomarkers for Alzheimer's disease in primary care: A French qualitative study exploring perspectives of general practitioners

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Alzheimer's disease (AD) remains the leading cause of neurocognitive disorders. Timely diagnosis is essential, ¹ but remains complex and often delayed ² . Blood‐based biomarkers offer a promising opportunity to improve diagnostic accessibility and reduce delays. Their exact role within care systems, especially whether they should be integrated into primary care, remains uncertain. ³ , ⁴ , ⁵ Because general practitioners (GPs) play a central role in identifying cognitive disorders, their perspectives are crucial. ⁵ , ⁶

We read with interest the article by Claessen and collaborators, who explored Dutch GPs’ perceptions of blood‐based biomarkers. ⁶ They reported enthusiasm about improved access to diagnosis but also concerns regarding overdiagnosis, patient anxiety, and the need for clear guidelines. Our study aimed to document how French GPs perceive this emerging tool.

Between February and March 2025, we conducted a qualitative study involving 13 GPs in the Auvergne‐Rhône‐Alpes region of France. Three semi‐structured focus groups were organized: one with five rural, one with four rural/semi‐rural, and one with four urban/semi‐rural GPs. Participant characteristics were balanced (seven men, six women), and ages were distributed as follows: five were 30–40, seven were 40–50, and one was over 50 years old. Discussions were audio‐recorded and analyzed thematically using inductive coding. Content analysis followed a structured process: transcription, reading, identify meaning units and initial codes, categorization, and interpretation of underlying themes. ⁷ The results were subsequently discussed with senior GPs and geriatricians. Here, we summarize briefly the main themes and topics highlighted by GPs (Figure 1).

FIGURE 1.

Themes and topics identified by GPs regarding their perspective on the potential arrival of blood‐based biomarkers. Mind map providing a visual presentation of the themes and topics identified by GPs in focus groups regarding their perspective on the potential arrival of blood‐based biomarkers in primary care. Themes represent overarching conceptual categories emerging from the analysis, while topics refer to the specific issues or sub‐elements that constitute each theme. *Indicates items that were not specifically highlighted in Claessen's study. GPs, general practitioners.

GPs expressed strong interest in blood‐based biomarkers, mainly because the current diagnostic pathway is perceived as slow and fragmented. They described difficulties accessing memory clinics, with delays sometimes exceeding several months. A rapid, interpretable test was therefore seen as a meaningful improvement, particularly for patients and caregivers who experience prolonged uncertainty. This aligns with findings from Claessen et al., who reported similar expectations regarding improved diagnostic accessibility (section 3.3).

Nevertheless, GPs emphasized that their main diagnostic priority lies in ruling out reversible causes of cognitive decline rather than determining precise etiologies. In the absence of disease‐modifying treatments (DMTs) in France, ⁸ most GPs see little benefit in distinguishing AD from other etiologies, as management remains mainly symptomatic. All agreed, however, that the introduction of DMTs would transform their approach, making blood‐based biomarkers a key tool for early diagnosis. The added value of biomarkers in the case of DMTs was also highlighted in Claessen's study (Section 3.5). Some expressed concerns that the biomarker could encourage “over‐diagnosis” or an overreliance on biological data detached from clinical context. This risk of misdiagnosis due to potential false‐positive and ‐negative tests was highlighted in Claessen's study (Section 3.2).

GPs noted relational and ethical issues, as diagnostic requests often came from caregivers rather than patients, who may minimize their symptoms. While biomarkers could help families and patients accept the diagnosis, some feared inappropriate testing demands. In Claessen's study, GPs shared concerns about inappropriate requests, particularly the possibility that patients might seek AD biomarker testing even in the absence of cognitive symptoms (Section 3.2). Furthermore, such tests may offer a viable alternative for patients who refuse referral to a memory clinic, supporting accurate diagnosis in primary care settings. For others, however, a positive test could heighten anxiety or reinforce stigma. GPs frequently cited the term “Alzheimer's” as carrying a strong emotional burden that could act as a barrier to disclosure, leading them to use less direct language. The “psychological burden” of AD was also noted by GPs in Claessen's study (Section 3.2).

A theme of ambivalence regarding GP autonomy emerged. While they welcomed accessible diagnostic tools—especially given specialist shortages—many felt uncomfortable assuming full responsibility for diagnosing and disclosing AD. Most GPs believed that biomarkers should initially be used within memory clinics, with a progressive transition to primary care once clear guidelines, dedicated training, and therapeutic advances are available. This hesitation was also reported by Dutch GPs (Section 3.1).

To conclude, French GPs expressed cautious optimism toward blood‐based biomarkers. They recognized their potential to accelerate diagnosis and streamline pathways but questioned their current clinical utility in the absence of DMTs. Their reflections highlight several challenges for implementation: ensuring sensitive patient communication, preserving nuanced clinical judgment, avoiding overreliance on biological data, and clarifying roles between primary care and specialists. Compared with Claessen et al., our findings place emphasis on relational and emotional dimensions, while Dutch GPs also emphasize practical and implementation challenges. Overall, integrating blood‐based biomarkers into future care pathways will require careful planning, interdisciplinarity, and attention to the perspectives of GPs.

CONFLICT OF INTEREST STATEMENT

This study was not funded and independent from pharmaceutical industry. Independent of this work, Antoine Garnier‐Crussard, an unpaid sub‐investigator or local principal investigator for clinical trials and studies sponsored by UCB Pharma, Biogen, TauRx Therapeutics, Roche, Novo Nordisk, Alzheon, Medesis Pharma, GlaxoSmithKline, and participated in studies granted by Roche, Lilly and Eisai. He declares that he has not received any personal funding and has not participated in any remunerated activities. Author disclosures are available in the Supporting Information.

FUNDING INFORMATION

None.

AI TECHNOLOGY USE

The first version of the manuscript was written in French by the authors and then translated and adapted to the journal's format using generative AI (ChatGPT‐5, Open AI version October 2025). This tool was only used to help with the translation from French to English and to edit the manuscript. The initial manuscript was written solely by the author, and the final version was edited and validated by the authors.

Supporting information

Supporting file 1: dad270301‐sup‐0001‐SuppMat.pdf