Multi-stream deep learning framework to predict mild cognitive impairment with Rey Complex Figure Test

Drawing tests like the Rey Complex Figure Test (RCFT) are widely used to assess cognitive functions such as visuospatial skills and memory, making them valuable tools for detecting mild cognitive impairment (MCI). Despite their utility, existing predictive models based on these tests often suffer from limitations like small sample sizes and lack of external validation, which undermine their reliability. We developed a multi-stream deep learning framework that integrates two distinct processing streams: a multi-head self-attention based spatial stream using raw RCFT images and a scoring stream employing a previously developed automated scoring system. Our model was trained on data from 1,740 subjects in the Korean cohort and validated on an external hospital dataset of 222 subjects from Korea. The proposed multi-stream model demonstrated superior performance over baseline models (AUC = 0.872, Accuracy = 0.781) in external validation. The integration of both spatial and scoring streams enables the model to capture intricate visual details from the raw images while also incorporating structured scoring data, which together enhance its ability to detect subtle cognitive impairments. This dual approach not only improves predictive accuracy but also increases the robustness of the model, making it more reliable in diverse clinical settings. Our model has practical implications for clinical settings, where it could serve as a cost-effective tool for early MCI screening.

A Quantitatively Interpretable Model for Alzheimer's Disease Prediction Using Deep Counterfactuals

Deep learning (DL) for predicting Alzheimer's disease (AD) has provided timely intervention in disease progression yet still demands attentive interpretability to explain how their DL models make definitive decisions. Recently, counterfactual reasoning has gained increasing attention in medical research because of its ability to provide a refined visual explanatory map. However, such visual explanatory maps based on visual inspection alone are insufficient unless we intuitively demonstrate their medical or neuroscientific validity via quantitative features. In this study, we synthesize the counterfactual-labeled structural MRIs using our proposed framework and transform it into a gray matter density map to measure its volumetric changes over the parcellated region of interest (ROI). We also devised a lightweight linear classifier to boost the effectiveness of constructed ROIs, promoted quantitative interpretation, and achieved comparable predictive performance to DL methods. Throughout this, our framework produces an ``AD-relatedness index'' for each ROI and offers an intuitive understanding of brain status for an individual patient and across patient groups with respect to AD progression.