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As a result, there is a need to identify a cognitive composite that is sensitive to track preclinical AD decline to be used as a primary endpoint in treatment trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Longitudinal data from initially cognitively normal, 70\u2010 to 85\u2010year\u2010old participants in three cohort studies of aging and dementia from the Rush Alzheimer's Disease Center were examined to empirically define a composite cognitive endpoint that is sensitive to detect and track cognitive decline before the onset of cognitive impairment. The mean\u2010to\u2010standard deviation ratios (MSDRs) of change over time were calculated in a search for the optimal combination of cognitive tests\/subtests drawn from the neuropsychological battery in cognitively normal participants who subsequently progressed to clinical stages of AD during 2\u2010 and 5\u2010year periods, using data from those who remained unimpaired during the same period to correct for aging and practice effects. Combinations that performed well were then evaluated for representation of relevant cognitive domains, robustness across individual years before diagnosis, and occurrence of selected items within top performing combinations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The optimal composite cognitive test score comprised seven cognitive tests\/subtests with an MSDR\u00a0=\u00a00.964. By comparison, the most sensitive individual test score was Logical Memory Delayed Recall with an MSDR\u00a0=\u00a00.64.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have identified a composite cognitive test score representing multiple cognitive domains that has improved power compared with the most sensitive single test item to track preclinical AD decline and evaluate preclinical AD treatments. We are confirming the power of the composite in independent cohorts and with other analytical approaches, which may result in refinements, have designated it as the primary endpoint in the Alzheimer's Prevention Initiative's preclinical treatment trials for individuals at high imminent risk for developing symptoms due to late\u2010onset AD.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jalz.2014.02.002","type":"journal-article","created":{"date-parts":[[2014,4,21]],"date-time":"2014-04-21T02:48:26Z","timestamp":1398048506000},"page":"666-674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":120,"title":["An empirically derived composite cognitive test score with improved power to track and evaluate treatments for preclinical Alzheimer's disease"],"prefix":"10.1002","volume":"10","author":[{"given":"Jessica B.","family":"Langbaum","sequence":"first","affiliation":[{"name":"Banner Alzheimer's Institute Phoenix AZ 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