Biomarkers in preclinical and early Alzheimer’s disease in China: a scoping review

• Biomarker research for early stages of AD surged in the past five years in China. • 86 high-performance biomarkers were identified in biomarker-confirmed AD patients. • Most biomarker studies address diagnosis, with a subset for preclinical and MCI-AD. • Seven biomarkers were well-validated across multiple Chinese AD cohorts for Aβ. • Many innovative biomarkers are under active development in Chinese AD cohorts. This scoping review synthesizes evidence on fluid and neuroimaging biomarkers for preclinical and early Alzheimer’s disease (AD)—including mild cognitive impairment (MCI) and mild AD dementia—in Chinese populations, where a comprehensive overview has been lacking despite AD's increasing biomarker-based definition. We systematically searched four English databases (PubMed, EMBASE, Cochrane, and Web of Science) and three Chinese databases (CNKI, Wanfang, and CQVIP) for studies (2013–2023) reporting diagnostic accuracy of these biomarkers in Chinese preclinical and early AD (eAD) cohorts for clinical use. Due to rapid advancements in biomarker research in China, a supplementary search was conducted in the four English databases for studies published between 2024 and April 30, 2025. Of the 366 included studies investigating fluid or neuroimaging biomarkers in AD, 48 specifically evaluated biomarker performance in biomarker‑confirmed AD populations. Plasma p-tau217 showed strong performance for diagnosing MCI due to AD, and plasma p-tau217, p-tau181/Aβ42, and p-tau217/Aβ42 effectively classified amyloid-β (Aβ) pathology. Multimodal combinations and MRI-based biomarkers also performed well, though evidence is limited. In China, biomarker diagnosis of MCI due to AD is advancing rapidly, while approaches for preclinical AD, machine learning, and multi-protein panels remain in early development.