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EXT improved prediction of cognitive decline (Preclinical Alzheimer Cognitive Composite) and tau proliferation (flortaucipir\u2010PET) over LVL.<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>These findings indicate EXT may be more sensitive to A\u03b2\u2019s role in preclinical AD than level and improve targeting of individuals for AD prevention trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>A\u03b2 spatial extent (EXT) was measured as the percentage of the neocortex with elevated Pittsburgh Compound\u2010B.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>A\u03b2 EXT improved detection of A\u03b2 below traditional PET thresholds.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Early regional A\u03b2 deposits were spatially heterogeneous.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Cognition and tau were more closely tied to A\u03b2 EXT than A\u03b2 level.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Neocortical tau onset aligned with reaching widespread neocortical A\u03b2.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.14036","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T01:49:48Z","timestamp":1720662588000},"page":"5434-5449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Spatial extent as a sensitive amyloid\u2010PET metric in preclinical Alzheimer's disease"],"prefix":"10.1002","volume":"20","author":[{"given":"Michelle E.","family":"Farrell","sequence":"first","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma G.","family":"Thibault","sequence":"additional","affiliation":[{"name":"Department of Radiology Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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