AbstractBackgroundAs an aging country with a large population, China has the largest population of patients with dementia in the world (10‐11million patients aged 60 years or older), accounting for approximately 25% of the entire population with dementia worldwide. Currently in China, due to the differences between tier 1, 2, and 3 hospitals (Fig 1), only at academic hospitals affiliated to medical university, the diagnosis of dementia is determined to standard procedures, while more patients with cognitive impairment are diagnosed by neurologists or internists without specialized training in dementia. Exosomes are an attractive source of biomarkers in AD, with its accessibility, generalizability and availability advantages over CSF or PET gold standard.MethodWe will present two of our latest findings based on two multicenter studies and explore the impact of novel blood and digital markers on dementia care in China.ResultOur latest findings indicated that exosomal biomarkers ‐ in particular, Aβ42, T‐tau, P‐T181‐tau, growth associated protein 43 (GAP43), neurogranin, synaptosome associated protein 25 (SNAP25), and synaptotagmin 1 ‐ had the same diagnostic power as the CSF biomarkers. Moreover, the combination of exosomal GAP43, neurogranin, SNAP25, and synaptotagmin 1 detected AD 5 to 7 years before cognitive impairment.ConclusionAccording to our latest results, exosomal biomarkers could predict AD at asymptomatic stage, making an effective intervention to slow or halt the progression of AD possible. Provided that diagnosis of dementia depends on validated plasma biomarkers, AD would be easily diagnosed in tier 1 or tier 2 hospitals in China. Then, tier1 or tier 2 hospital will play more important role in AD diagnosis, monitoring and patients’ enrolment in clinical trials. Tier 3 hospitals will focus on the diagnosis and treatment of difficult and complicated cases transferred from tier 1 or tier 2 hospitals as well as treatment decision. They will have more time and resources for exploring new mechanism, interventions, translational research and clinical trials.