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Compared to the rapidly evolved understanding and measurement of pathophysiology in preclinical and early symptomatic stages of Alzheimer's disease (AD), relatively less progress has been made in the evolution of clinical outcome assessments (COAs) for those stages. The current paper aims to provide a benchmark for the design and evaluation of COAs for use in early AD trials. We discuss lessons learned on capturing cognitive changes in predementia stages of AD, including challenges when validating novel COAs for those early stages and necessary evidence for their implementation in clinical trials. Moving forward, we propose a multi\u2010step framework to advance the use of more effective COAs to assess clinically meaningful changes in early AD, which will hopefully contribute to the much\u2010needed consensus around more appropriate outcome measures to assess clinical efficacy of putative treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>We discuss lessons learned on capturing cognitive changes in predementia stages of AD.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>We propose a framework for the design and evaluation of performance based cognitive tests for use in early AD trials.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>We provide recommendations to facilitate the implementation of more effective cognitive outcome measures in AD trials.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.12773","type":"journal-article","created":{"date-parts":[[2022,9,10]],"date-time":"2022-09-10T04:23:45Z","timestamp":1662783825000},"page":"708-720","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":83,"title":["Why a clinical trial is as good as its outcome measure: A framework for the selection and use of cognitive outcome measures for clinical trials of Alzheimer's disease"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3712-4790","authenticated-orcid":false,"given":"Roos J.","family":"Jutten","sequence":"first","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn V.","family":"Papp","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Neurology Brigham and Women's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Hendrix","sequence":"additional","affiliation":[{"name":"Pentara Corporation  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Ellison","sequence":"additional","affiliation":[{"name":"Pentara Corporation  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica B.","family":"Langbaum","sequence":"additional","affiliation":[{"name":"Banner Alzheimer's Institute  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Donohue","sequence":"additional","affiliation":[{"name":"Alzheimer's Therapeutic Research Institute Keck School of Medicine University of Southern California  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Hassenstab","sequence":"additional","affiliation":[{"name":"Knight Alzheimer Disease Research Center Department of Neurology Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Maruff","sequence":"additional","affiliation":[{"name":"Cogstate Ltd.  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