AI and Non AI Assessments for Dementia

Current progress in the artificial intelligence domain has led to the development of various types of AI-powered dementia assessments, which can be employed to identify patients at the early stage of dementia. It can revolutionize the dementia care settings. It is essential that the medical community be aware of various AI assessments and choose them considering their degrees of validity, efficiency, practicality, reliability, and accuracy concerning the early identification of patients with dementia (PwD). On the other hand, AI developers should be informed about various non-AI assessments as well as recently developed AI assessments. Thus, this paper, which can be readable by both clinicians and AI engineers, fills the gap in the literature in explaining the existing solutions for the recognition of dementia to clinicians, as well as the techniques used and the most widespread dementia datasets to AI engineers. It follows a review of papers on AI and non-AI assessments for dementia to provide valuable information about various dementia assessments for both the AI and medical communities. The discussion and conclusion highlight the most prominent research directions and the maturity of existing solutions.Comment: 49 page

Formulaic Language in People with Probable Alzheimer's Disease: A Frequency-Based Approach

BACKGROUND: Language change can be a valuable biological marker of overall cognitive change in Alzheimer's disease (AD) and other forms of dementia. Previous reports have described increased use of language formulas in AD, i.e., combinations likely processed in a holistic manner. Words that commonly occur together are more likely to become a formula. OBJECTIVE: To determine if frequency of co-occurrence as one indicator for formulaic language can distinguish people with probable AD from controls and if variables are sensitive to time post-symptom onset. METHODS: We developed the Frequency in Language Analysis Tool (FLAT), which indicates degrees of formulaicity in an individual language sample. The FLAT accomplishes this by comparing individual language samples to co-occurrence data from the British National Corpus (BNC). Our analysis also contained more conventional language variables in order to assess novel contributions of the FLAT. We analyzed data from the Pitt Corpus, which is part of DementiaBank. RESULTS: Both conventional and co-occurrence variables were able to distinguish AD and control groups. According to co-occurrence data, people with probable AD produced more formulaic language than controls. Only co-occurrence variables correlated with disease progression. DISCUSSION: Frequency of word co-occurrences is one indicator for formulaicity and a valuable contribution to characterizing language change in AD

Detección de desórdenes de lenguaje de pacientes con enfermedad de Alzheimer usando embebimientos de palabras y características gramaticales

Alzheimer's Disease (AD) is a progressive neurodegenerative disorder that affects the language production and thinking capabilities of patients. The integrity of the brain is destroyed over time by interruptions in the interactions between neuron cells and associated cells required for normal brain functioning. AD comprises deterioration of the communicative skills, which is reflected in deficient speech that usually contains no coherent information, low density of ideas, and poor grammar. Additionally, patients exhibit difficulties to find appropriate words to structure sentences. Multiple ongoing studies aim to detect the disease considering the deterioration of language production in AD patients. Natural Language Processing techniques are employed to detect patterns that can be used to recognize the language impairments of patients. This paper covers advances in pattern recognition with the use of word-embedding and word-frequency features and a new approach with grammar features. We processed transcripts of 98 AD patients and 98 healthy controls in the Pitt Corpus of the Dementia-Bank database. A total of 1200 word-embedding features, 1408 Term Frequency—Inverse Document Frequency features, and 8 grammar features were extracted from the selected transcripts. Three models are proposed based on the separate extraction of such feature sets, and a fourth model is based on an early fusion strategy of the proposed feature sets. All the models were optimized following a Leave-One-Out cross validation strategy. Accuracies of up to 81.7 % were achieved using the early fusion of the three feature sets. Furthermore, we found that, with a small set of grammar features, accuracy values of up to 72.8 % were obtained. The results show that such features are suitable to effectively classify AD patients and healthy controls.La enfermedad de Alzheimer es un desorden neurodegenerativo-progresivo que afecta la producción de lenguaje y las capacidades de pensamiento de los pacientes. La integridad del cerebro es destruida con el paso del tiempo por interrupciones en las interacciones entre neuronas y células, requeridas para su funcionamiento normal. La enfermedad incluye el deterioro de habilidades comunicativas por un habla deficiente, que usualmente contiene información inservible, baja densidad de ideas y habilidades gramaticales. Adicionalmente, los pacientes presentan dificultades para encontrar palabras apropiadas y así estructurar oraciones. Por lo anterior, hay investigaciones en curso que buscan detectar la enfermedad considerando el deterioro de la producción de lenguaje. Así mismo, se están usando técnicas de procesamiento de lenguaje natural para detectar patrones y reconocer las discapacidades del lenguaje de los pacientes. Por su parte, este artículo se enfoca en el uso de características basadas en embebimiento y frecuencia de palabras, además de hacer una nueva aproximación con características gramaticales para clasificar la enfermedad de Alzheimer. Para ello, se consideraron transcripciones de 98 pacientes con Alzheimer y 98 controles sanos del Pitt Corpus incluido en la base de datos Dementia-Bank. Un total de 1200 características de embebimientos de palabras, 1408 características de frecuencia de término inverso vs. frecuencia en documentos, y 8 características gramaticales fueron calculadas. Tres modelos fueron propuestos, basados en la extracción de dichos conjuntos de características por separado y un cuarto modelo fue basado en una estrategia de fusión temprana de los tres conjuntos de características. Los modelos fueron optimizados usando la estrategia de validación cruzada Leave-One-Out. Se alcanzaron tasas de aciertos de hasta 81.7 % usando la fusión temprana de todas las características. Además, se encontró que un pequeño conjunto de características gramaticales logró una tasa de acierto del 72.8 %. Así, los resultados indican que estas características son adecuadas para clasificar de manera efectiva entre pacientes de Alzheimer y controles sanos

How to do things with (thousands of) words: Computational approaches to discourse analysis in Alzheimer's disease.

Natural Language Processing (NLP) is an ever-growing field of computational science that aims to model natural human language. Combined with advances in machine learning, which learns patterns in data, it offers practical capabilities including automated language analysis. These approaches have garnered interest from clinical researchers seeking to understand the breakdown of language due to pathological changes in the brain, offering fast, replicable and objective methods. The study of Alzheimer's disease (AD), and preclinical Mild Cognitive Impairment (MCI), suggests that changes in discourse (connected speech or writing) may be key to early detection of disease. There is currently no disease-modifying treatment for AD, the leading cause of dementia in people over the age of 65, but detection of those at risk of developing the disease could help with the identification and testing of medications which can take effect before the underlying pathology has irreversibly spread. We outline important components of natural language, as well as NLP tools and approaches with which they can be extracted, analysed and used for disease identification and risk prediction. We review literature using these tools to model discourse across the spectrum of AD, including the contribution of machine learning approaches and Automatic Speech Recognition (ASR). We conclude that NLP and machine learning techniques are starting to greatly enhance research in the field, with measurable and quantifiable language components showing promise for early detection of disease, but there remain research and practical challenges for clinical implementation of these approaches. Challenges discussed include the availability of large and diverse datasets, ethics of data collection and sharing, diagnostic specificity and clinical acceptability

Changes in cognitive domains during three years in patients with Alzheimer's disease treated with donepezil

<p>Abstract</p> <p>Background</p> <p>The objective was to identify separate cognitive domains in the standard assessment tools (MMSE, ADAS-Cog) and analyze the process of decline within domains during three years in Alzheimer's disease (AD) patients with donepezil treatment.</p> <p>Method</p> <p>AD patients (n = 421) were recruited from a clinical multi-centre study program in Sweden. Patients were assessed every six months during three years. All patients received donepezil starting directly after study entry. After dropouts, 158 patients remained for analyses over three years. Data for the other patients were analysed until they dropped out (4 groups based on length in study).</p> <p>Results</p> <p>Factor analyses of all items suggested that there were three intercorrelated factors: a General, a Memory and a Spatial factor for which we constructed corresponding domains. Overall there was a cognitive improvement at six months followed by a linear drop over time for the three domains. Some group and domain differences were identified. Patients who remained longer in the study had better initial performance and a slower deterioration rate. The early dropouts showed no improvement at six months and many dropped out due to side effects. The other groups displayed a performance improvement at six months that was less pronounced in the Memory domain. Before dropping out, deterioration accelerated, particularly in the Spatial domain.</p> <p>Conclusion</p> <p>The course of illness in the three domains was heterogeneous among the patients. We were not able to identify any clinically relevant correlates of this heterogeneity. As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.</p

Automatic hierarchical attention neural network for detecting AD

Picture description tasks are used for the detection of cognitive decline associated with Alzheimer’s disease (AD). Recent years have seen work on automatic AD detection in picture descriptions based on acoustic and word-based analysis of the speech. These methods have shown some success but lack an ability to capture any higher level effects of cognitive decline on the patient’s language. In this paper, we propose a novel model that encompasses both the hierarchical and sequential structure of the description and detect its informative units by attention mechanism. Automatic speech recognition (ASR) and punctuation restoration are used to transcribe and segment the data. Using the DementiaBank database of people with AD as well as healthy controls (HC), we obtain an F-score of 84.43% and 74.37% when using manual and automatic transcripts respectively. We further explore the effect of adding additional data (a total of 33 descriptions collected using a ‘ digital doctor’ ) during model training, and increase the F-score when using ASR transcripts to 76.09%. This outperforms baseline models, including bidirectional LSTM and bidirectional hierarchical neural network without an attention mechanism, and demonstrate that the use of hierarchical models with attention mechanism improves the AD/HC discrimination performance

Linguistic- and Acoustic-based Automatic Dementia Detection using Deep Learning Methods

Dementia can affect a person's speech and language abilities, even in the early stages. Dementia is incurable, but early detection can enable treatment that can slow down and maintain mental function. Therefore, early diagnosis of dementia is of great importance. However, current dementia detection procedures in clinical practice are expensive, invasive, and sometimes inaccurate. In comparison, computational tools based on the automatic analysis of spoken language have the potential to be applied as a cheap, easy-to-use, and objective clinical assistance tool for dementia detection. In recent years, several studies have shown promise in this area. However, most studies focus heavily on the machine learning aspects and, as a consequence, often lack sufficient incorporation of clinical knowledge. Many studies also concentrate on clinically less relevant tasks such as the distinction between HC and people with AD which is relatively easy and therefore less interesting both in terms of the machine learning and the clinical application. The studies in this thesis concentrate on automatically identifying signs of neurodegenerative dementia in the early stages and distinguishing them from other clinical, diagnostic categories related to memory problems: (FMD, MCI, and HC). A key focus, when designing the proposed systems has been to better consider (and incorporate) currently used clinical knowledge and also to bear in mind how these machine-learning based systems could be translated for use in real clinical settings. Firstly, a state-of-the-art end-to-end system is constructed for extracting linguistic information from automatically transcribed spontaneous speech. The system's architecture is based on hierarchical principles thereby mimicking those used in clinical practice where information at both word-, sentence- and paragraph-level is used when extracting information to be used for diagnosis. Secondly, hand-crafted features are designed that are based on clinical knowledge of the importance of pausing and rhythm. These are successfully joined with features extracted from the end-to-end system. Thirdly, different classification tasks are explored, each set up so as to represent the types of diagnostic decision-making that is relevant in clinical practice. Finally, experiments are conducted to explore how to better deal with the known problem of confounding and overlapping symptoms on speech and language from age and cognitive decline. A multi-task system is constructed that takes age into account while predicting cognitive decline. The studies use the publicly available DementiaBank dataset as well as the IVA dataset, which has been collected by our collaborators at the Royal Hallamshire Hospital, UK. In conclusion, this thesis proposes multiple methods of using speech and language information for dementia detection with state-of-the-art deep learning technologies, confirming the automatic system's potential for dementia detection