This study modeled predementia Alzheimer’s disease (AD) clinical trials. Longitudinal data from cognitively normal (CN) and mild cognitive impairment (MCI) participants in the AD Neuroimaging Initiative were used to calculate sample size requirements for trials using outcome measures including: the Clinical Dementia Rating scale sum of boxes (CDR-sb), Mini Mental Status Examination (MMSE), AD assessment scale-cognitive subscale with and without delayed recall, and the Rey Auditory Verbal Learning task (RAVLT). We examined the impact on sample sizes of enrichment for genetic and biomarker criteria, including cerebrospinal fluid protein and neuroimaging analyses. We observed little cognitive decline in the CN population at 36 months, regardless of the enrichment strategy. Nonetheless, in CN subjects, using RAVLT total as an outcome at 36 months required the fewest subjects across enrichment strategies, with apolipoprotein E genotype ε4 carrier status requiring the fewest (n=499 per arm to demonstrate a 25% reduction in disease progression). In MCI, enrichment reduced the required sample sizes for trials, relative to estimates based on all subjects. For MCI, the CDR-sb consistently required the smallest sample sizes. We conclude that predementia clinical trial conduct in AD is enhanced by the use of biomarker inclusion criteria.
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