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- There is currently no tool for predicting how quickly early stage Alzheimer’s disease will progress.
- A new study has identified a simple blood test used to measure insulin resistance that may also help doctors determine which people with early stage Alzheimer’s disease are most likely to experience rapid cognitive decline.
- The test found that higher insulin resistance indicated quicker deterioration in cognitive decline.
Researchers estimate that about
People in the earliest stage of Alzheimer’s disease begin to experience some mild cognitive impairment that may affect their memory and ability to complete tasks and communicate.
Past studies show that detecting Alzheimer’s disease in its earliest stage allows currently available medications and lifestyle changes to be more effective in helping to slow down disease progression.
“Alzheimer’s (disease) begins silently, often decades before symptoms appear, and so detecting risk early is essential to slow or alter the disease course,” Bianca Gumina, MD, a neurology resident for the Neurology Unit in the Department of Clinical and Experimental Sciences at the University of Brescia and for the Neurology Unit in the Department of Continuity of Care and Frailty at ASST Spedali Civili Hospital, both in Italy, told Medical News Today.
“Current tools can diagnose the disease, but they don’t always predict how fast it will progress. Identifying individuals at higher risk of rapid decline [c]ould allow for timely, targeted interventions during a critical window when the disease could be still responsive to treatment or changes in (lifestyle),” she said.
Gumina is part of the research team for a study recently presented at the European Academy of Neurology (EAN) Congress 2025 that has identified a simple blood test used to measure insulin resistance that may also help doctors determine which people with early stage Alzheimer’s disease are most likely to experience rapid cognitive decline.
The findings of the study are yet to be published in a peer-reviewed journal.
For this study, researchers analyzed medical records from 315 adults with an average age of about 70 that did not have diabetes. Two hundred of the study participants had received biological confirmation they had Alzheimer’s disease.
All study participants received insulin resistance assessment using a test called the triglyceride-glucose (TyG) index, with a clinical follow-up three years later.
“The TyG index is a validated marker of insulin resistance, a condition often seen in prediabetes or metabolic syndrome,” Gumina explained. “It combines triglycerides and fasting blood glucose, two common and non-invasive blood values. (It is) easy to calculate and already available in routine labs.”
At the study’s conclusion, the research team found that when grouping study participants by their TyG index results, those in the highest TyG index group experienced a quicker deterioration in cognitive decline than those with lower TyG index results.
4-fold higher risk“This finding is significant because it highlights a vulnerable window (mild cognitive impairment, the early phase of the disease) when the disease may be especially sensitive to metabolic stress. Patients in this early phase with high TyG levels had a fourfold increased risk of rapid cognitive decline compared to those with lower TyG levels. This suggests that insulin resistance may actively influence how fast Alzheimer’s progresses, and identifying this risk early could open new avenues for intervention.”
— Bianca Gumina, MD
“The TyG index is a low-cost, widely available tool that could be easily integrated into routine clinical practice to flag patients at higher risk of rapid decline,” she continued. “By identifying these individuals early, clinicians could prioritize them for closer monitoring, lifestyle interventions, or even enrollment in clinical trials, maybe individualizing sub
As for the next steps in this research, Gumina said the research group is currently exploring whether the TyG index also correlates with neuroimaging
“The next goal is to integrate metabolic profiling with genetic and imaging data to refine risk models and guide early, personalized interventions,” she added.
MNT spoke with Rehan Aziz, MD, geriatric psychiatrist at Jersey Shore University Medical Center in New Jersey, about this study.
Aziz commented that he thought this was a very interesting study involving a new variable to consider when working with patients in the early stages of Alzheimer’s dementia, especially as it may predict who is likely to decline faster.
“Accurate progression prediction is crucial for multiple reasons,” he explained. “It empowers families to make informed decisions about care planning, financial arrangements, and how to prioritize quality time together. Clinically, it helps us identify patients who need more intensive monitoring and earlier intervention.”
“With new disease-modifying treatments like
“This metabolic marker could help us personalize the risk-benefit calculation for each patient, ensuring we’re offering these powerful but potentially risky therapies to those who need them most while protecting slower-progressing patients from unnecessary exposure.”
— Rehan Aziz, MD
Aziz said he’d like to see this study’s results validated in larger populations.
“We also need longer follow-up studies to see if this predictive power holds over five to 10 years,” he continued. “I’m particularly interested in whether interventions targeting insulin resistance — like lifestyle modifications or medications like metformin — could actually slow progression in high-TyG patients. Finally, I’d like to see this integrated with other biomarkers to create a more comprehensive risk stratification tool.”
MNT also spoke with Peter Gliebus, MD, director of cognitive and behavioral neurology at Marcus Neuroscience Institute, part of Baptist Health South Florida, about this research.
Gliebus commented that he found the study both fascinating and highly applicable to daily clinical practice.
“As clinicians, we frequently encounter questions from patients and their families, such as, ‘How quickly will it worsen?’— and we often don’t have a definitive answer,” he explained.
“The prospect that a simple, cost-effective marker like the TyG index could predict progression in Alzheimer’s disease is extremely encouraging. It has the potential to bridge an important gap between diagnosis and practical prognosis, which has been a missing element in this field,” he said.
“Early-stage Alzheimer’s, especially during the mild cognitive impairment stage, exhibits significant variability-some individuals remain stable for years, while others decline rapidly. Identifying those at higher risk of swift decline enables us to customize clinical care and research strategies. It also helps families set clearer expectations and facilitates early, potentially more effective interventions, whether through lifestyle changes, medications or future planning.”
— Peter Gliebus, MD
“As new treatments are developed, timing and patient stratification will be essential — tools like the TyG index may play a crucial role in that process,” he added.
