Re-centring Neuropsychology: A Feedback Model for Early Alzheimer's Disease

Advances in plasma and neuroimaging biomarkers have transformed Alzheimer’s disease (AD) diagnosis, yet risk marginalizing neuropsychology’s interpretive role. The NIA–AA “AT(N)” framework redefined AD as a biological entity measurable through amyloid, tau, and neurodegeneration, but detached pathology from cognition. This theoretical paper re-centres neuropsychology by proposing the Biomarker–Cognition Feedback Loop (BCFL), a dynamic model conceptualizing early AD as an interactive continuum in which molecular pathology and cognitive adaptation co-evolve. Integrating predictive processing and cognitive reserve theories, the BCFL reframes cognition as both outcome and regulator of pathology, offering a multidimensional foundation for early detection and ethical diagnosis. This is a theoretical position paper proposing an integrative neuropsychological model of early Alzheimer’s, reinterpreting biomarkers and cognition within a unified feedback framework.