A easy nasal swab might provide an surprising window into the earliest organic alerts of Alzheimer’s disease.
Alzheimer’s disease affects millions worldwide, but it is most difficult to detect in its earliest stages, when treatment may be most effective.
A new study from Duke Health suggests that a simple outpatient nasal swab could reveal early biological signs of the disease, even before problems with memory and thinking begin.
Published in Nature Communications, the study used a soft swab inserted high inside the nasal cavity to collect nerve and immune cells. Analysis of these cells revealed distinct patterns that distinguished individuals with early or diagnosed Alzheimer’s from those without the condition.
“We want to be able to confirm Alzheimer’s very early, before damage has a chance to build up in the brain,” said Bradley J. Goldstein, M.D., Ph.D., corresponding author and professor in the departments of Head and Neck Surgery & Communication Sciences, Cell Biology and Neurobiology at Duke University School of Medicine.
“If we can diagnose people early enough, we might be able to start therapies that prevent them from ever developing clinical Alzheimer’s,” Goldstein said.
How the Nasal Swab Works
Collecting the nasal samples takes only a few minutes. After a numbing spray is applied, a clinician inserts a small brush into the upper nasal cavity, where smell-related nerve cells are located. Researchers then examine the collected cells to determine which genes are active, offering clues about processes occurring in the brain.
The study analyzed samples from 22 participants, tracking the activity of thousands of genes across hundreds of thousands of individual cells, generating millions of data points. The test detected early changes in both nerve and immune cells, including in people who showed laboratory signs of Alzheimer’s but had not yet developed symptoms.
A combined gene score based on nasal tissue correctly distinguished early and clinical Alzheimer’s cases from healthy individuals about 81% of the time.
Mary Umstead, a volunteer in the study, said she chose to participate in honor of her late sister, Mariah Umstead.
“When the opportunity came along to be part of a research study, I just jumped at it because I would never want any family to have to go through that kind of loss that we went through with Mariah,” Mary said. “I would never want any patient to go through what she went through either.”
Mary said Mariah was 57 years old when she was diagnosed with young-onset Alzheimer’s, though the family had noticed symptoms long before her diagnosis.
Advantages Over Existing Tests
Current blood tests for Alzheimer’s typically detect markers that appear later in the disease. In contrast, this nasal approach measures activity in living nerve and immune cells, offering a more immediate view of disease-related changes and potentially identifying at-risk individuals earlier.
“Much of what we know about Alzheimer’s comes from autopsy tissue,” said Vincent M. D’Anniballe, the study’s first author and student in the Medical Scientist Training Program at Duke. “Now we can study living neural tissue, opening new possibilities for diagnosis and treatment.”
The Duke research team, working with the Duke & UNC Alzheimer’s Disease Research Center, is expanding the study to larger groups. They are also investigating whether the nasal swab could be used to monitor treatment response over time. Duke has filed a U.S. patent related to this method.
Reference: “Olfactory cleft biopsy analysis of Alzheimer’s disease pathobiology across disease stages” by Vincent M. D’Anniballe, Sarah Kim, John B. Finlay, Michael Wang, Tiffany Ko, Sheng Luo, Heather E. Whitson, Kim G. Johnson and Bradley J. Goldstein, 18 March 2026, Nature Communications.
DOI: 10.1038/s41467-026-70099-7
This study is funded by the National Institutes of Health (R01 AG082335, R25 DC020172, and P30 AG072958.)
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