Ultrasensitive saliva-based detection of early Alzheimer’s disease biomarkers via nanoparticle-enhanced evanescent scattering microscopy

Alzheimer’s disease (AD) is the most common neurodegenerative disease, yet early diagnosis remains a major challenge. Current cerebrospinal fluid (CSF) assays are invasive and unsuitable for large-scale or repeated screening. Blood-based biomarkers have achieved sensitivities above 90%, but still face challenges of standardization, cost, technical complexity, and the need for sophisticated instrumentation. Saliva offers an attractive, non-invasive solution; however, the low concentrations of AD biomarkers have thus far hindered its clinical applicability. Here, we introduce a saliva-based diagnostic platform that combines Total Internal Reflection Scattering (TIRS) microscopy with antibody-functionalized metallic nanoparticles (NPs), for ultrasensitive, real-time quantification of salivary amyloid-β (Aβ) proteins. Using two established AD mouse models (APP sl and 5xFAD), we found that salivary Aβ₄₂ levels robustly distinguish transgenic from wild-type animals and correlate with brain amyloid deposition. Pooled and stratified analyses suggest these associations are primarily driven by the transgenic-wild-type contrast rather than linear changes within groups. Predictive modeling further confirmed diagnostic utility: in APP sl , Logistic Regression and Support Vector Machine (SVM) classifiers both achieved 92% accuracy with balanced sensitivity and specificity, while in 5xFAD, SVM reached 88% accuracy with perfect specificity. These results establish the NPs-enhanced TIRS sensor as a rapid, accurate and non-invasive tool for AD detection via saliva. By addressing a critical unmet need in neurodegenerative disease screening, this platform has strong potential to transform early diagnosis, enable timely interventions, and support biomarker-guided clinical trials. Its simplicity, speed, and scalability, make it well-suited for point-of-care diagnostics and large-scale screening initiatives. One Sentence Summary Ultrasensitive saliva test detects early Alzheimer’s biomarkers using nanoparticle-enhanced scattering microscopy