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

Process Dissociation Analyses of Memory Changes in Healthy Aging, Preclinical, and Very Mild Alzheimer Disease: Evidence for Isolated Recollection Deficits

Recollection and familiarity are independent processes that contribute to memory performance. Recollection is dependent on attentional control, which breaks down in early-stage Alzheimer disease (AD), whereas familiarity is independent of attention. The present study examines the sensitivity of recollection estimates based on Jacoby’s (1991) process dissociation procedure to AD-related biomarkers in a large sample of well-characterized cognitively normal older adults (N = 519) and the extent to which recollection discriminates these individuals from individuals with very mild symptomatic AD (N = 64). Participants studied word pairs, e.g., “knee bone,” then completed a primed, explicit, cued fragment-completion memory task, e.g., “knee b_n_.” Primes were either congruent with the correct response, e.g., “bone,” incongruent, e.g., “bend,” or neutral, e.g., “&&&.” This design allowed for the estimation of independent contributions of recollection and familiarity processes, using the process dissociation procedure. Recollection, but not familiarity, was impaired in healthy aging and in very mild AD. Recollection discriminated cognitively normal individuals from the earliest detectable stage of symptomatic AD above and beyond standard psychometric tests. In cognitively normal individuals, baseline CSF measures indicative of AD pathology were related to lower initial recollection and less improvement in recollection over time. Finally, presence of amyloid plaques, as imaged by PIB-PET, was related to less improvement in recollection over time. These findings suggest that attention-demanding memory processes, such as recollection, may be particularly sensitive to both symptomatic and preclinical AD pathology

VOCAL BIOMARKERS OF CLINICAL DEPRESSION: WORKING TOWARDS AN INTEGRATED MODEL OF DEPRESSION AND SPEECH

Speech output has long been considered a sensitive marker of a person’s mental state. It has been previously examined as a possible biomarker for diagnosis and treatment response for certain mental health conditions, including clinical depression. To date, it has been difficult to draw robust conclusions from past results due to diversity in samples, speech material, investigated parameters, and analytical methods. Within this exploratory study of speech in clinically depressed individuals, articulatory and phonatory behaviours are examined in relation to psychomotor symptom profiles and overall symptom severity. A systematic review provided context from the existing body of knowledge on the effects of depression on speech, and provided context for experimental setup within this body of work. Examinations of vowel space, monophthong, and diphthong productions as well as a multivariate acoustic analysis of other speech parameters (e.g., F0 range, perturbation measures, composite measures, etc.) are undertaken with the goal of creating a working model of the effects of depression on speech. Initial results demonstrate that overall vowel space area was not different between depressed and healthy speakers, but on closer inspection, this was due to more specific deficits seen in depressed patients along the first formant (F1) axis. Speakers with depression were more likely to produce centralised vowels along F1, as compared to F2—and this was more pronounced for low-front vowels, which are more complex given the degree of tongue-jaw coupling required for production. This pattern was seen in both monophthong and diphthong productions. Other articulatory and phonatory measures were inspected in a factor analysis as well, suggesting additional vocal biomarkers for consideration in diagnosis and treatment assessment of depression—including aperiodicity measures (e.g., higher shimmer and jitter), changes in spectral slope and tilt, and additive noise measures such as increased harmonics-to-noise ratio. Intonation was also affected by diagnostic status, but only for specific speech tasks. These results suggest that laryngeal and articulatory control is reduced by depression. Findings support the clinical utility of combining Ellgring and Scherer’s (1996) psychomotor retardation and social-emotional hypotheses to explain the effects of depression on speech, which suggest observed changes are due to a combination of cognitive, psycho-physiological and motoric mechanisms. Ultimately, depressive speech is able to be modelled along a continuum of hypo- to hyper-speech, where depressed individuals are able to assess communicative situations, assess speech requirements, and then engage in the minimum amount of motoric output necessary to convey their message. As speakers fluctuate with depressive symptoms throughout the course of their disorder, they move along the hypo-hyper-speech continuum and their speech is impacted accordingly. Recommendations for future clinical investigations of the effects of depression on speech are also presented, including suggestions for recording and reporting standards. Results contribute towards cross-disciplinary research into speech analysis between the fields of psychiatry, computer science, and speech science

A longitudinal observational study of home-based conversations for detecting early dementia:protocol for the CUBOId TV task

INTRODUCTION: Limitations in effective dementia therapies mean that early diagnosis and monitoring are critical for disease management, but current clinical tools are impractical and/or unreliable, and disregard short-term symptom variability. Behavioural biomarkers of cognitive decline, such as speech, sleep and activity patterns, can manifest prodromal pathological changes. They can be continuously measured at home with smart sensing technologies, and permit leveraging of interpersonal interactions for optimising diagnostic and prognostic performance. Here we describe the ContinUous behavioural Biomarkers Of cognitive Impairment (CUBOId) study, which explores the feasibility of multimodal data fusion for in-home monitoring of mild cognitive impairment (MCI) and early Alzheimer’s disease (AD). The report focuses on a subset of CUBOId participants who perform a novel speech task, the ‘TV task’, designed to track changes in ecologically valid conversations with disease progression. METHODS AND ANALYSIS: CUBOId is a longitudinal observational study. Participants have diagnoses of MCI or AD, and controls are their live-in partners with no such diagnosis. Multimodal activity data were passively acquired from wearables and in-home fixed sensors over timespans of 8–25 months. At two time points participants completed the TV task over 5 days by recording audio of their conversations as they watched a favourite TV programme, with further testing to be completed after removal of the sensor installations. Behavioural testing is supported by neuropsychological assessment for deriving ground truths on cognitive status. Deep learning will be used to generate fused multimodal activity-speech embeddings for optimisation of diagnostic and predictive performance from speech alone. ETHICS AND DISSEMINATION: CUBOId was approved by an NHS Research Ethics Committee (Wales REC; ref: 18/WA/0158) and is sponsored by University of Bristol. It is supported by the National Institute for Health Research Clinical Research Network West of England. Results will be reported at conferences and in peer-reviewed scientific journals

Computational Language Assessment in patients with speech, language, and communication impairments

Speech, language, and communication symptoms enable the early detection, diagnosis, treatment planning, and monitoring of neurocognitive disease progression. Nevertheless, traditional manual neurologic assessment, the speech and language evaluation standard, is time-consuming and resource-intensive for clinicians. We argue that Computational Language Assessment (C.L.A.) is an improvement over conventional manual neurological assessment. Using machine learning, natural language processing, and signal processing, C.L.A. provides a neuro-cognitive evaluation of speech, language, and communication in elderly and high-risk individuals for dementia. ii. facilitates the diagnosis, prognosis, and therapy efficacy in at-risk and language-impaired populations; and iii. allows easier extensibility to assess patients from a wide range of languages. Also, C.L.A. employs Artificial Intelligence models to inform theory on the relationship between language symptoms and their neural bases. It significantly advances our ability to optimize the prevention and treatment of elderly individuals with communication disorders, allowing them to age gracefully with social engagement.Comment: 36 pages, 2 figures, to be submite

Functional neural correlates of first-episode psychoses during sensory, cognitive, language, and emotional processing

Background. Numerosi studi hanno evidenziato che i pazienti affetti da esordi sindromici dello spettro schizofrenico presentano alterazioni neurofunzionali durante l’esecuzione di compiti che coinvolgono le funzioni sensoriali, cognitive, linguistiche ed emotive. Obiettivo. Paragonare pazienti con esordio psicotico a individui sani al fine di studiare il network neurale coinvolto nelle risposte a compiti sensoriali, cognitive, linguistiche ed emotive, identificando le similarità e le differenze nelle attivazioni cerebrali correlate all’esecuzione degli stessi compiti. Metodo. Abbiamo eseguito una meta-analisi ALE utilizzando il database costruito su ventisei studi di risonanza magnetica funzionale condotti su 516 pazienti con esordio e 546 soggetti sani durante l’esecuzione di task sensoriali, cognitivi, linguistici ed emotivi. Risultati. Le analisi within-group hanno dimostrato che i controlli sani manifestavano in risposta a tutti i task attivazioni significative in un circuito bilaterale fronto-parietale, mentre i pazienti in un circuito bilaterale parietale-precentrale. Le analisi between-groups hanno evidenziato iperattivazioni del lobulo parietale inferiore di destra, del giro medio frontale sinistro e della corteccia temporale destra nei sani e del cingolo di destra nei pazienti. L’analisi condotta separatamente per gruppi di compiti ha evidenziato che la performance di task attentivo-mnestici si correlava ad attivazione di aree prefrontali nei sani e parietali bilaterali negli esordi; l’esecuzione di task emotivi si correlava ad attivazione della corteccia dorsolaterale prefrontale (DLPFC) bilaterale, della corteccia parietale destra, del cingolo di sinistra e dell’amigdala di destra nei sani e del giro fusiforme di destra nei pazienti; solo i sani hanno evidenziato attivazioni in aree corticali di sinistra incentrate sull’insula, la DLPFC e la corteccia temporale in correlazione a compiti linguistici. Conclusioni. Il risultato principale di questa meta-analisi è l’evidenza di deficit funzionale della DLPFC di sinistra in pazienti con esordio psicotico durante l’esecuzione di task sensoriali, cognitivi, linguistici ed emotivi. Il giro del cingolo di destra, le cortecce parietali e la temporale di destra hanno anch’esse un ruolo importante nella neurofisiopatologia degli esordi. Questo studio ha anche evidenziato che i pazienti attivano circuiti cerebrali diversi rispetto ai sani in risposta a compiti attentivo-mnestici (attivazione predominante in aree parietali bilaterali), emotivi (attivazione predominante nel giro fusiforme destro) e linguistici (mancata attivazione di aree corticali di sinistra).Background: Several studies reported neural functional alterations in patients with schizophrenia spectrum first-episode psychosis (FEP) during performance of tasks that involve sensory, attentional memory, language, and emotional (SAMLE) processing. Aim: To compare meta-analytically FEP and healthy control (CTR) samples regarding the circuitries engaged in responding to a set of SAMLE tasks and identifying commonalities and differences in task-related brain activations. Method: We performed an activation likelihood estimation (ALE) meta-analysis using a database built on 26 fMRI studies, conducted on 516 FEP patients and 546 CTRs during SAMLE task performance. Results: Within-Group analyses showed that the CTR group has significant SAMLE task-related cortical activations in the context of a bilateral fronto-parietal network; FEP patients showed taskrelated activations of a bilateral parietal-precentral network. Between-Groups analyses showed hyperactivation of the right inferior parietal lobule, left middle frontal gyrus, and right temporal cortex in CTRs, and hyperactivation of the right cingulate gyrus in FEP. Segregated analyses of tasks showed that brain activations to attentional and memory-related tasks mainly occurred in prefrontal areas in CTRs, and in bilateral parietal areas in FEP; emotional task-related activations concerned the bilateral dorsolateral prefrontal cortex (DLPFC), right parietal cortex, left cingulate cortex and right amygdala in CTRs, whereas in FEP the activation concerned the right fusiform gyrus; we found significant left-sided language task-related activations only in the CTR group, centred on the insula, DLPFC, and temporal cortex. Conclusions: The major finding of this study is the evidence of a functional deficit of the left DLPFC in FEP during the SAMLE task performance. A prominent role in the neuropathophysiology of FEP appears also to be played by the right dorsal anterior cingulate, bilateral parietal, and right temporal cortices. This study also underlined that FEP patients activate different circuits than CTRs in response to attentional- and memory-tasks (predominant activation of bilateral parietal areas), emotional (predominant activation of the right fusiform gyrus), and language (lack of activation of left-sided cortical areas) tasks