Perceptions of the use of biomarkers for Alzheimer’s disease diagnosis: A systematic review and synthesis of the qualitative literature

Biomarker investigations are increasingly used in the diagnostic assessment of Alzheimer’s disease (AD), yet stakeholder perceptions and implementation factors remain underexplored. No systematic qualitative synthesis exists on these views. A systematic review searched four databases up to May 2025 for English-language qualitative studies on stakeholder (healthcare professionals, caregivers, patients) perspectives. A meta-ethnographic approach synthesised findings, with barriers/enablers classified using the Theoretical Domains Framework (TDF). From 4,319 records, 26 studies were included, yielding five key concepts: stakeholder expectations, test result significance, shared decision-making, diagnostic certainty, and test delivery systems. Barriers included lack of understanding (Knowledge) and emotional burden (Emotion). Enablers involved supporting decision-making (Memory, attention, decision processes) and beliefs about testing benefits (Beliefs about consequences), though risks were equally noted. Barriers to AD biomarker use involve multiple TDF domains, with contrasting stakeholder viewpoints. Improving knowledge of biomarkers and addressing perceived benefits and risks can guide interventions, promoting more effective test use.