Alzheimer’s disease affects millions of people worldwide, yet it remains hardest to catch at the very beginning—precisely when new treatments may work best.
In a new study, Duke Health researchers have found a surprising way to pick up early biological changes linked to Alzheimer’s, even before thinking and memory problems appear: a quick, outpatient nasal swab.
The study, published March 18 in Nature Communications, used a gentle swab placed high inside the nose to collect nerve and immune cells. Analysis of these cells revealed clear patterns that separated people with early or diagnosed Alzheimer’s from those without the disease.
“We want to be able to confirm Alzheimer’s very early, before damage has a chance to build up in the brain,” said Bradley J. Goldstein, M.D., Ph.D., corresponding author and professor in the departments of Head and Neck Surgery & Communication Sciences, Cell Biology and Neurobiology at Duke University School of Medicine. “If we can diagnose people early enough, we might be able to start therapies that prevent them from ever developing clinical Alzheimer’s.”
How it works
The procedure to collect nasal cells takes just a few minutes. After applying a numbing spray, a clinician guides a tiny brush into the upper part of the nose where smell-detecting nerve cells live. Researchers then study the collected cells to see which genes are active—a sign of what’s happening inside the brain.
In this study, the team compared samples from 22 participants, measuring the activity of thousands of genes across hundreds of thousands of individual cells, amounting to millions of data points. The nasal swab was able to pick up early shifts in nerve and immune cells, including people who showed lab-based signs of Alzheimer’s but had no symptoms yet.
A combined gene score from the nasal tissue correctly distinguished early and clinical Alzheimer’s from healthy controls about 81 per cent of the time.
A personal reason to participate
For voluntary participant Mary Umstead, joining the study had personal significance. Her late sister Mariah was 57 years old when she was diagnosed with young-onset Alzheimer's, though her family had started noticing signs of the disease long before she was diagnosed.
“When the opportunity came along to be part of a research study, I just jumped at it because I would never want any family to have to go through that kind of loss that we went through with Mariah,” Mary said.
“I would never want any patient to go through what she went through either.”
A different window into the brain
Current blood tests for Alzheimer’s detect markers that appear later in the disease process. By contrast, this nasal swab captures living nerve and immune activity, potentially offering an earlier, more direct look at disease‑related changes, helping identify people at risk sooner.
“Much of what we know about Alzheimer’s comes from autopsy tissue,” said Vincent M. D’Anniballe, the study’s first author and student in the Medical Scientist Training Program at Duke. “Now we can study living neural tissue, opening new possibilities for diagnosis and treatment.”
What’s next
In addition to Goldstein and D’Anniballe, this study— funded by the National Institutes of Health—also includes co-authors Sarah Kim, John B. Finlay, Michael Wang, Tiffany Ko, Sheng Luo, Heather E. Whitson, and Kim G. Johnson.
This Duke team, in collaboration with the Duke & UNC Alzheimer’s Disease Research Center, is now expanding the research to larger groups and exploring whether the swab could help track how well treatments are working over time. Duke has filed a US patent related to this approach.
For now, the nasal swab remains a research tool, but it is a step on the path towards a way of catching Alzheimer’s at its quietest, most treatable stage—long before a single memory fades.
Adapted from "Nasal swab test spots early Alzheimer’s signals"