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Article History

Accepted: 15 July 2025

First Online: 29 July 2025

Declarations

:

: The study received approval from the Swedish Ethical Review Authority (DNR: 2024-07272-02). Ethical approvals for NACC were obtained from the local institutional review boards at each participating site. The NACC request ID for this study is 11753.

: In accordance with Swedish regulations, we are unable to share the data used in this study. Researchers can access SveDem and other Swedish registers after receiving ethical approvals from ethical review authorities and approvals from the register holders. Analysis codes for the study, including codes for the meta-analyses of utility, are available at: .

: All authors, including AW and BW, have reviewed the manuscript, provided critical feedback, and approved the submission of the manuscript for publication.

: RH has received consulting fees in the past 36 months from Lilly Nederland and the Institute for Medical Technology Assessment (paid to institution), outside this study. BW has served on scientific advisory boards for Alzinova, Axon Neuroscience, Artery Therapeutics, NSC-Therapeutics, and Phanes Biotech and on a data safety monitoring board for Primus-AD. SK has served on scientific advisory boards and as a speaker and/or consultant for Roche, Eli Lilly, Geras Solutions, Optoceutics, Biogen, Eisai, Merry Life, Triolab, Novo Nordisk, and Bioarctic, unrelated to the present study content. HZ has served on scientific advisory boards and/or as a consultant for AbbVie, Acumen, Alector, Alzinova, ALZpath, Amylyx, Annexon, Apellis, Artery Therapeutics, AZTherapies, Cognito Therapeutics, CogRx, Denali, Eisai, Enigma, LabCorp, Merry Life, Nervgen, Novo Nordisk, Optoceutics, Passage Bio, Pinteon Therapeutics, Prothena, Quanterix, Red Abbey Labs, reMYND, Roche, Samumed, Siemens Healthineers, Triplet Therapeutics, and Wave; has given lectures sponsored by Alzecure, BioArctic, Biogen, Cellectricon, Fujirebio, Lilly, Novo Nordisk, Roche, and WebMD; and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program (outside the submitted work). LJ has received research grants (unrelated to the current work) from Novo Nordisk; consultancy fees from Lundbeck, Eli Lilly, and Teva; and licence fees for the RUD (resource utilization in dementia) instrument. LJ is an editorial board member of PharmacoEconomics and was not involved in the selection of peer reviewers for the manuscript or any of the subsequent editorial decisions. AW and BW have received licence fees for the RUD instrument. ME has served as consultant for BioArctic AB, Roche, Eli Lilly, Biogen/Eisai, and Novo Nordisk and given lectures in symposia sponsored by Roche. XX, SA, OF, EA, YL, and TS have no competing interests.

: Open access funding provided by Karolinska Institute. This project is supported by the Innovative Health Initiative Joint Undertaking (IHI JU) under grant agreement no. 101112145 and PREDEM (Vinnova grant 2021-02680). The JU receives support from the European Union’s Horizon Europe research and innovation programme, Combinostics Oy and BioArctic AB. The views and opinions expressed are those of the authors and do not necessarily reflect those of the aforementioned parties. Neither of the aforementioned parties can be held responsible for them. BW has received research funding from Margaretha af Ugglas’ foundation, Swedish Research Council (2024-03573), and Swedish Brain Foundation (FO2024-0287). HZ is a Wallenberg Scholar and a Distinguished Professor at the Swedish Research Council supported by grants from the Swedish Research Council (#2023-00356, #2022-01018 and #2019-02397), the European Union’s Horizon Europe research and innovation programme under grant agreement no. 101053962, and Swedish State Support for Clinical Research (#ALFGBG-71320). SK was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-1005471, ALFGBG-965923, ALFGBG-81392, ALFGBG-771071), the Alzheimerfonden (AF-842471, AF-737641, AF-929959, AF-939825), the Swedish Research Council (2019-02075, 2019-02075_15), Stiftelsen Psykiatriska Forskningsfonden, and the Swedish Brain Foundation (FO2024-0097). ME was supported by the Swedish Research Council (2024-03599), the Swedish Brain Foundation (FO2024-0339), the regional agreement on medical training and clinical research between the Stockholm County council and the Karolinska Institutet (ALF) and the Paulsson foundation.