Perspective: Emerging challenges for a future ADNI.

In the last two decades, the Alzheimer's Disease Neuroimaging Initiative (ADNI) has significantly advanced our understanding, technologies, and methods for detecting and diagnosing Alzheimer's disease and related dementias. This perspective proposes repurposing ADNI to address emerging research and healthcare challenges. The focus would shift toward early detection of cognitive impairment, discovering new interventions, evaluating non-pharmacological treatments, adopting a public health approach, and enrolling a diverse international cohort. Key elements of this new model include emphasizing vascular-metabolic factors, leveraging biomarkers, and enhancing computational capabilities. By reimagining ADNI's mission and framework, the initiative may be better poised to tackle the evolving complexities of dementia research and improve patient outcomes through a more comprehensive, multidisciplinary approach. HIGHLIGHTS: ADNI should be repurposed for early detection and intervention in cognitive decline. This would emphasize vascular-metabolic factors and biomarkers in dementia research. It advocates for non-pharmacological evaluations and a public health approach. It promotes international cohort studies and enhanced computational capacity.