Three and a half years. That is how long it takes, on average, from the moment a patient first notices something is wrong to the moment they receive a full diagnosis for Alzheimer's or another neurodegenerative disease. It is not a data point that startles most people in healthcare. It is a data point that most people in healthcare have quietly accepted.

StartUp Health community member Danguole Altman has not accepted it.

As CEO of Cx Precision Medicine, Altman is leading a company built on a deceptively focused question: what if primary care physicians had a simple, affordable, AI-powered blood test to help them decide, at the very first visit, whether a patient's memory symptoms are likely caused by Alzheimer's or something else entirely?

The answer to that question, she believes, could reshape the neurodegenerative disease diagnostic landscape from the ground up.

The diagnostic journey for patients with Alzheimer's, Parkinson's, and related neurodegenerative diseases is not just emotionally difficult. It is structurally broken.

Patients typically start with their primary care physician, which is the right instinct. But those physicians, working in resource-constrained environments with limited time and limited tools, often cannot do much more than refer patients onward. From symptoms to a specialty referral can take six to twelve months. From there, the workup deepens: neuropsychological testing, MRI, amyloid blood tests, and in many cases a PET scan. The full diagnostic complex, taken together, is expensive, time-consuming, and often inaccessible.

"It's three and a half years from when that patient first realizes they have symptoms and sees a physician to when they actually have a full diagnosis," Altman says. "A lot of that is because patients start with their primary care physicians and those primary care physicians really don't have the full set of tools to move those patients forward."

The deeper problem is what happens during those three and a half years. Early Alzheimer's symptoms, particularly at the mild cognitive impairment (MCI) stage, are difficult to distinguish from a range of other conditions: long COVID, menopause, anxiety, sleep apnea, vascular issues, or metabolic conditions. A primary care physician facing a patient who feels "off" but has no dramatic symptoms has few reliable tools for determining what is actually driving the concern. The default too often becomes "wait and see."

But waiting has consequences. Every approved Alzheimer's therapy, every neuromodulation device in the pipeline, every lifestyle intervention documented in research like the POINTER study, all of them are designed for patients who are caught early. By the time a patient reaches moderate or severe disease, the intervention window has already closed.

"Once you hit moderate or severe, it's a problem," Altman says. "You've missed that effectiveness window of intervention."

CxPM's answer to this problem is NeuroFirst Memory, a blood-based triage test designed specifically for primary care use. The test is not intended to diagnose Alzheimer's or identify amyloid tau pathology. It is designed to do something more foundational: rule out. To give a primary care physician, quickly and affordably, a scientifically grounded signal as to whether a symptomatic patient's memory complaints are likely caused by Alzheimer's-related dementia and should be moved forward for specialty evaluation, or whether they are likely caused by something else.

That distinction matters enormously for the patient sitting across the desk. For the roughly 80% of symptomatic patients 60 and older who are expected to be ruled out by the test, it means faster answers, a clearer path to addressing what is actually going on, and none of the cost or complexity of a full specialty workup. For the 20% who are not ruled out, it means an accelerated path to the right evaluation at a time when treatments can still make a difference.

"If you are ruled out, that gives a lot of peace of mind and then a much more accurate diagnosis," Altman says. "Maybe they have sleep apnea. Maybe they have hearing issues that have not been caught. That then allows a deeper dive into what is causing the memory issues."

The science underlying NeuroFirst Memory is grounded in some of the most extensive neurodegenerative disease research available. CxPM's technology is built on licensed work from the laboratory of Scientific Founder Sid O'Bryant, PhD, a neuropsychologist at the University of North Texas Health Science Center. Dr. O'Bryant knows this problem from the inside: it was watching his own grandmother wait more than a year and spend thousands of dollars to get clarity on her cognitive decline that set him on the path to building a research foundation capable of producing tools like NeuroFirst Memory. His lab has since assembled one of the largest multi-ethnic biomarker datasets in the field, comprising thousands of characterized patient samples across multiple longitudinal studies.

The platform itself is a multiplex immunoassay, designed from the start for automation and scale. Unlike tests requiring individual handling, CxPM's system can run thousands of samples in a single week, a structural advantage that becomes increasingly significant as volume builds and costs come down.

One of the most practically important decisions CxPM has made is how it has positioned NeuroFirst Memory from a reimbursement standpoint. The company has deliberately designed the test as a triage tool rather than a screening test, a distinction that has significant implications for insurance coverage.

Medicare, established in the mid-1960s, reimburses a defined set of screening tests, including mammography and certain cancer screenings, but does not cover general screening tests for conditions not on that list. It is a structural limitation that has created reimbursement challenges for other diagnostic innovators, including Grail, whose Galleri multi-cancer early detection test launched as a lab-developed test in mid-2021 and has generated more than $250 million in direct patient-pay revenue through 2025 without achieving Medicare coverage. Grail's experience demonstrates both the ceiling that comes with a screening-test designation and the floor of demand that exists among patients willing to pay out of pocket.

CxPM's triage positioning keeps it on the covered side of that line. A physician-ordered triage test for a symptomatic patient is a fundamentally different regulatory and reimbursement category than a population-wide screening test, and CxPM has built its go-to-market path accordingly.

Altman is also candid that the long-term vision extends beyond the triage use case. At scale, with broad access and falling costs, a test like NeuroFirst Memory could have relevance for a much wider population. "If this test is available to me and I'm going to see my concierge physician, and you take the insurance piece off the table, someone's able to pay," she says. "Why wouldn't you go ahead and take that test?"

NeuroFirst Memory is CxPM's lead product, but the company's pipeline reflects a broader vision for where neurodegenerative diagnostics need to go.

NeuroFirst Parkinson's is now in active development, applying the same triage philosophy to patients presenting with essential tremors, gait issues, or other early motor symptoms that can be difficult to distinguish from non-Parkinson's causes at the primary care level. Altman describes progress on that front over the past year as meaningful.

Beyond the triage tests, CxPM is also beginning to think through a next generation of precision diagnostics focused on Alzheimer's subtypes. The field is increasingly recognizing that Alzheimer's disease has historically been defined by symptoms and by amyloid pathology in ways that obscure significant heterogeneity underneath. Neuroinflammatory presentations, metabolic subtypes, and other variant pathologies all fall under the same diagnostic umbrella. Dr. O'Bryant's lab has made progress using blood samples from failed drug trials to identify these subtypes, pointing toward a future in which a CxPM reflex panel could help stratify patients after an initial Alzheimer's diagnosis.

"That is the next precision medicine for us," Altman says. "It is really that next frontier in the diagnostic journey."

Altman is thoughtful about where all of this fits within the broader arc of healthcare AI. Her view is that the field has moved quickly on the most tractable problems, back-end administrative efficiency, claims processing, documentation, and early-stage drug discovery, while the harder work of using AI to meaningfully improve clinical outcomes and bridge the gap between health tech and life sciences has barely begun.

"The true innovation will be on connecting those different spheres," she says. "The verticals have historically been health tech investors, life sciences investors, healthcare services. But the true opportunity is in intersecting them, using the information that is available to really drive meaningful outcomes."

She is direct that the bridge between clinical decision support and life sciences is one that still needs to be built, but believes the infrastructure for it is rapidly falling into place. AI as a tool for informing clinical decisions in real time, rather than as an agent or an administrative assistant, is where she sees the most important near-term opportunity.

CxPM is planning to launch NeuroFirst Memory as a lab-developed test on a limited geographic basis within the next 12 months, with a broader rollout to follow as the beta phase validates operations and scale. The company is currently launching a Series A to fund that acceleration.

For investors, the case is grounded in a combination of clinical rigor, a scalable platform architecture, a defensible reimbursement strategy, and a market where the unmet need is quantifiable in years of delay and billions of dollars in unnecessary diagnostic spending.

For patients, the case is simpler. You should not have to wait three and a half years to find out what is happening inside your own mind.

"There is so much opportunity," Altman says, "and the time to really act is now."

We are proud to have Danguole Altman, Dr. Sid O'Bryant, and the Cx Precision Medicine team as members of the StartUp Health Alzheimer’s & Brain Health Moonshot Community.