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While the development of the Preclinical Alzheimer\u2019s Cognitive Composite (PACC) addresses this need, its lack of language-specific markers might limit its sensitivity, given that language deficits are among the earliest manifestations of AD. To address this limitation, we developed PACC variants incorporating proper names delayed recall, a novel lexical-semantic marker robustly linked to PET and CSF biomarkers. We analysed 824 dementia-free participants (mean age \u2248 62 at baseline) from the Wisconsin Registry for Alzheimer\u2019s Prevention, stratifying them by plasma phosphorylated tau 217 (p-tau217) levels (using established amyloid PET positivity cut-offs: negative [&amp;lt;0.40\u2005pg\/mL; N = 539], intermediate [0.40\u20130.63\u2005pg\/mL; N = 163], positive [&amp;gt;0.63\u2005pg\/mL; N = 122]). We constructed six PACC variants: (1) traditional PACC4 (Rey Auditory Verbal Learning Test immediate learning, Logical Memory II [LM II; delayed recall], Digit Symbol, Mini-Mental State Examination [MMSE]); (2) PACC3 (excluding MMSE to mitigate ceiling effects); (3\u20134) PACC4_PN and PACC3_PN, replacing LM II\u2019s total score with proper-name recall; and (5\u20136) PACC4 + VF and PACC3 + VF, adding animal fluency. Cognitive composites were calculated as the equally weighted sum of component z-scores. We compared PACC variants\u2032sensitivity (i.e. longitudinal decline rates) associated with plasma p-tau217, using linear mixed models adjusted for age, gender, literacy and practice (total visits minus one). We showed individuals with positive plasma p-tau217 status exhibited significantly faster cognitive decline across all PACCs. Notably, the proper name enhanced-PACC, especially the parsimonious PACC3_PN, demonstrated the steepest decline\u20146.4\u201319% faster than the traditional and animal fluency-appended versions. Our optimized measure offers critical advantages in clinical utility: an 82% reduction in scoring burden for clinicians (9-point proper names versus 50-point total LM score), finer semantic memory granularity within an episodic memory task and enhanced sensitivity to AD biomarkers. Our findings position proper name-enhanced PACC as a clinically practical tool for tracking longitudinal cognitive trajectories, highlighting proper names delayed recall as a sensitive marker due to AD-type brain changes. Future work will validate its utility for trial enrichment and clinical screening.<\/jats:p>","DOI":"10.1093\/braincomms\/fcag163","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:26:42Z","timestamp":1777980402000},"source":"Crossref","is-referenced-by-count":0,"title":["Enhanced sensitivity to plasma p-tau217 with proper names recall in the preclinical Alzheimer\u2019s cognitive composite"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4690-6871","authenticated-orcid":false,"given":"Deling","family":"He","sequence":"first","affiliation":[{"name":"Department of Communication Sciences and Disorders, University of Wisconsin-Madison , Madison, WI 53705 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Langhough","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer's Disease Research Center, University of Wisconsin\u2013Madison School of Medicine and Public Health , Madison, WI 53792 ,","place":["USA"]},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin\u2014Madison School of Medicine and Public Health , Madison, WI 53726 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Jonaitis","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Wisconsin-Madison , Madison, WI 53705 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Wilson","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer's Disease Research Center, University of Wisconsin\u2013Madison School of Medicine and Public Health , Madison, WI 53792 ,","place":["USA"]},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin\u2014Madison School of Medicine and Public Health , Madison, WI 53726 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0133-4427","authenticated-orcid":false,"given":"Bruce","family":"Hermann","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison , Madison, WI 53705 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3930-4354","authenticated-orcid":false,"given":"Henrik","family":"Zetterberg","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer's Disease Research Center, University of Wisconsin\u2013Madison School of Medicine and Public Health , Madison, WI 53792 ,","place":["USA"]},{"name":"Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg , M\u00f6lndal SE-413 45 ,","place":["Sweden"]},{"name":"Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , M\u00f6lndal SE-431 80 ,","place":["Sweden"]},{"name":"Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health , Madison, WI 53705-2281 ,","place":["USA"]},{"name":"Department of Neurodegenerative Disease, UCL Institute of Neurology , Queen Square, London WC1N 3BG ,","place":["UK"]},{"name":"UK Dementia Research Institute at UCL , London NW1 3BT ,","place":["UK"]},{"name":"Centre for Brain Research, Indian Institute of Science , Bangalore 560012 ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sterling","family":"Johnson","sequence":"additional","affiliation":[{"name":"Wisconsin Alzheimer's Disease Research Center, University of Wisconsin\u2013Madison School of Medicine and Public Health , Madison, WI 53792 ,","place":["USA"]},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin\u2014Madison School of Medicine and Public Health , Madison, WI 53726 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8691-9517","authenticated-orcid":false,"given":"Kimberly D","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences and Disorders, University of Wisconsin-Madison , Madison, WI 53705 ,","place":["USA"]},{"name":"Wisconsin Alzheimer's Disease Research Center, University of Wisconsin\u2013Madison School of Medicine and Public Health , Madison, WI 53792 ,","place":["USA"]},{"name":"Wisconsin Alzheimer\u2019s Institute, University of Wisconsin\u2014Madison School of Medicine and Public Health , Madison, WI 53726 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"issue":"4","key":"2026052202063855300_fcag163-B1","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jalz.2018.02.018","article-title":"NIA-AA research 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