With an aging U.S. population, advancements in the treatment of Alzheimer disease (AD) and other neurodegenerative diseases are key to the maximization of health span. The recent approval of 2 antiamyloid antibodies, which decrease brain amyloid load, places us on the cusp of breakthrough therapies that target the mechanism of the disease rather than just treating the symptoms. Although the trials that led to these approvals studied patients with mild early symptoms, multiple ongoing trials have enrolled cognitively normal patients screened for AD biomarkers including risk factors for amyloid positivity, family history, and genetic markers. Thus, amyloid PET can help identify an at-risk population that can be enrolled for antiamyloid therapy to prevent AD symptoms from ever developing. In this review, we examine the paradigm of neurotheranostics and how PET biomarkers of amyloid, tau, inflammation, and neurodegeneration could characterize the pathologic stage of AD and therefore allow for personalized therapy.
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