title: Assessing risk for preclinical β-amyloid pathology withAPOE, cognitive, and demographic information.
abstract: BACKGROUND
  Clinical trials in Alzheimer's disease are aimed at early stages of disease, including preclinical Alzheimer's disease. The high cost and time required to screen large numbers of participants for Aβ pathology impede the development of novel drugs. This study's objective was to evaluate the extent to which inexpensive and easily obtainable information can reduce the number of screen failures by increasing the proportion of Aβ+ participants identified for screening.
  
  
  METHODS
  We used random forest models to evaluate the positive predictive value of demographics,APOE, and longitudinal cognitive rates in the prediction of amyloid pathology, measured by florbetapir PET or cerebrospinal fluid.
  
  
  RESULTS
  Predicting Aβ positivity with demographic,APOE, and cognitive information yielded a positive predictive value estimate of 0.65 (95% CI, 0.50-0.96), nearly a 60% increase over the reference Aβ+ prevalence in the cohort of 0.41.
  
  
  CONCLUSIONS
  By incorporating this procedure, clinical trial screening costs of 7500 USD per participant may be reduced by nearly 7 million USD total.
authors.affiliation: Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Insel
authors.affiliation: Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Palmqvist
authors.affiliation: Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Mackin
authors.affiliation: Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Nosheny
authors.affiliation: Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden.
authors.forename: Oskar
authors.initials: O
authors.lastname: Hansson
authors.affiliation: Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Weiner
authors.affiliation: Clinical Memory Research Unit, Faculty of Medicine, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Mattsson
keywords: APOE; Amyloid; Clinical trials; Cognition; Preclinical Alzheimer's