Estimating sample sizes for predementia Alzheimer's trials based on the Alzheimer's Disease Neuroimaging Initiative

Joshua D. Grill, Lijie Di, Po H. Lu, Cathy Lee, John Ringman, Liana G. Apostolova, Nicole Chow, Omid Kohannim, Jeffrey L. Cummings, Paul M. Thompson, David Elashoff

Research output: Contribution to journalArticle

34 Scopus citations


This study modeled predementia Alzheimer's disease clinical trials. Longitudinal data from cognitively normal (CN) and mild cognitive impairment (MCI) participants in the Alzheimer's Disease Neuroimaging Initiative were used to calculate sample size requirements for trials using outcome measures, including the Clinical Dementia Rating scale sum of boxes, Mini-Mental State Examination, Alzheimer's Disease Assessment Scale-cognitive subscale with and without delayed recall, and the Rey Auditory Verbal Learning Task. We examined the impact on sample sizes of enrichment for genetic and biomarker criteria, including cerebrospinal fluid protein and neuroimaging analyses. We observed little cognitive decline in the CN population at 36 months, regardless of the enrichment strategy. Nonetheless, in CN subjects, using Rey Auditory Verbal Learning Task total as an outcome at 36 months required the fewest subjects across enrichment strategies, with apolipoprotein E genotype ε4 carrier status requiring the fewest (n = 499 per arm to demonstrate a 25% reduction in disease progression). In MCI, enrichment reduced the required sample sizes for trials, relative to estimates based on all subjects. For MCI, the Clinical Dementia Rating scale sum of boxes consistently required the smallest sample sizes. We conclude that predementia clinical trial conduct in Alzheimer's disease is enhanced by the use of biomarker inclusion criteria.

Original languageEnglish (US)
Pages (from-to)62-72
Number of pages11
JournalNeurobiology of Aging
Issue number1
StatePublished - Jan 1 2013



  • Alzheimer's disease
  • Clinical trials
  • Enrichment
  • Mild cognitive impairment
  • Preclinical
  • Predementia
  • Sample size

ASJC Scopus subject areas

  • Neuroscience(all)
  • Aging
  • Clinical Neurology
  • Developmental Biology
  • Geriatrics and Gerontology

Cite this

Grill, J. D., Di, L., Lu, P. H., Lee, C., Ringman, J., Apostolova, L. G., Chow, N., Kohannim, O., Cummings, J. L., Thompson, P. M., & Elashoff, D. (2013). Estimating sample sizes for predementia Alzheimer's trials based on the Alzheimer's Disease Neuroimaging Initiative. Neurobiology of Aging, 34(1), 62-72.