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INTRODUCTION Predicting risk for Alzheimer’s disease when most people are likely still biomarker negative would aid earlier identification. We hypothesized that combining multiple memory tests and scores in middle-aged adults would provide useful, and non-invasive, prediction of 6-year progression to MCI. METHODS We examined 849 men who were cognitively normal at baseline (mean age=55.69±2.45). RESULTS California Verbal Learning Test learning trials was the best individual predictor of amnestic MCI (OR=4.75). A latent factor incorporating 7 measures across 3 memory tests provided much stronger prediction (OR=9.88). This compared favorably with biomarker-based prediction in a study of much older adults. DISCUSSION Neuropsychological tests are sensitive and early indicators of Alzheimer’s disease risk at an age when few individuals are likely to have yet become biomarker positive. Single best measures may appear time- and cost-effective, but 30 additional minutes of testing, and use of multiple scores within tests, provides substantially improved prediction

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