Clinical Core REVISED Abstract: Progress in early risk detection, diagnosis, treatment, and prevention of Alzheimer’s Disease (AD) depends critically on the availability of large “trial-ready” cohorts of participants spanning a spectrum from cognitively unimpaired to MCI-risk stages including subjective cognitive decline, mild cognitive impairment (MCI), and early AD, and ultimately autopsy-confirmed AD and related dementias (ADRD). The PITT-ADRC Clinical Core has effectively accomplished this with clinical evaluation and characterization of a cohort of more than 5300 participants since 1985, enrolling over 430 new participants in this funding cycle thus far. The Clinical Core is both a vital local research resource, providing participant referrals, biologic samples, diagnostic expertise, and training for numerous federally funded grants to local investigators, and a leading contributor to large scale national and international collaborative investigations including genetic and imaging biomarker studies and large-scale prevention trials. In the current grant cycle, the Clinical Core implemented measures to improve recruitment and retention of a wide range of high-risk participants; those residing in neighborhoods with the most high-risk individuals now account for just over 50% of initial visits. Area Deprivation Index and other key metrics will be monitored monthly in a new dashboard to be implemented in the next funding cycle to track recruitment goals in real time, including autopsy program recruitment. In the current cycle, in collaboration with the NIC, AT(N) neuroimaging biomarkers were systematically incorporated into the diagnostic consensus process. In the next funding cycle, in collaboration with the BGN Core, ATX(N) blood biomarkers will be similarly incorporated, to evaluate how these biomarkers might be practically utilized in clinical diagnosis and biological staging. Other new initiatives in the renewal cycle include a pilot study evaluating remote d