title: Disease progression model for Clinical Dementia Rating-Sum of Boxes in mild cognitive impairment and Alzheimer's subjects from the Alzheimer's Disease Neuroimaging Initiative.
abstract: BACKGROUND
  The objective of this analysis was to develop a nonlinear disease progression model, using an expanded set of covariates that captures the longitudinal Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB) scores. These were derived from the Alzheimer's Disease Neuroimaging Initiative ADNI-1 study, of 301 Alzheimer's disease and mild cognitive impairment patients who were followed for 2-3 years.
  
  
  METHODS
  The model describes progression rate and baseline disease score as a function of covariates. The covariates that were tested fell into five groups: a) hippocampal volume; b) serum and cerebrospinal fluid (CSF) biomarkers; c) demographics and apolipoprotein Epsilon 4 (ApoE4) allele status; d) baseline cognitive tests; and e) disease state and comedications.
  
  
  RESULTS
  Covariates associated with baseline disease severity were disease state, hippocampal volume, and comedication use. Disease progression rate was influenced by baseline CSF biomarkers, Trail-Making Test part A score, delayed logical memory test score, and current level of impairment as measured by CDR-SB. The rate of disease progression was dependent on disease severity, with intermediate scores around the inflection point score of 10 exhibiting high disease progression rate. The CDR-SB disease progression rate in a typical patient, with late mild cognitive impairment and mild Alzheimer's disease, was estimated to be approximately 0.5 and 1.4 points/year, respectively.
  
  
  CONCLUSIONS
  In conclusion, this model describes disease progression in terms of CDR-SB changes in patients and its dependency on novel covariates. The CSF biomarkers included in the model discriminate mild cognitive impairment subjects as progressors and nonprogressors. Therefore, the model may be utilized for optimizing study designs, through patient population enrichment and clinical trial simulations.
authors.affiliation: Janssen Research and Development, LLC, Raritan, New Jersey, USA.
authors.forename: Mahesh N
authors.initials: MN
authors.lastname: Samtani
authors.affiliation: Janssen Research and Development, LLC, Raritan, New Jersey, USA.
authors.forename: Nandini
authors.initials: N
authors.lastname: Raghavan
authors.affiliation: Janssen Research and Development, LLC, Raritan, New Jersey, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Novak
authors.affiliation: Janssen Research and Development, LLC, Raritan, New Jersey, USA.
authors.forename: Partha
authors.initials: P
authors.lastname: Nandy
authors.affiliation: Janssen Research and Development, LLC, Raritan, New Jersey, USA.
authors.forename: Vaibhav A
authors.initials: VA
authors.lastname: Narayan
keywords: CSF Aβ1–42; NONMEM®; beta-regression; hippocampal volume; trial enrichment