Clinimetrics: Towards a diagnostic neuropsychology grounded in Alzheimer's disease

Abstract Neuropsychology's place in diagnosing dementia is still up for debate. With the advent of disease‐modifying therapies, the optimisation of diagnostic pathways is increasingly urgent, particularly in the early stages of Alzheimer's disease. Yet, biomarker‐driven frameworks eclipse neuropsychological testing as an ancillary tool rather than recognising it as a core component of clinical assessment. Emerging evidence indicates that relying solely on biomarkers does not provide a dependable forecast for the onset or progression of dementia. This drawback underscores how important neuropsychology is. Nonetheless, the clinical adoption of neuropsychological tests for diagnostic purposes requires a paradigm shift towards a more rigorous methodology. Despite its recognised diagnostic potential, the current neuropsychological framework is constrained by thresholds derived from normative distributions rather than Clinimetrics . Many existing tests rely on arbitrary cut‐offs that do not account for disease prevalence, personological variability, or real‐world cognitive performance. This oversimplified approach reduces the sensitivity of neuropsychological assessments and limits their integration into clinical practice. The development of population‐specific clinimetric studies that establish weighted cut‐offs for sensitivity and specificity based on clinical aims is crucial to ensure clinically meaningful decision‐making.