Maryam Zolnoori

Maryam Zolnoori, Hossein Azadmaleki, Yasaman Haghbin et al.

Alzheimer's disease and related dementias (ADRD) affect one in five adults over 60, yet more than half of individuals with cognitive decline remain undiagnosed. Speech-based assessments show promise for early detection, as phonetic motor planning deficits alter acoustic features (e.g., pitch, tone), while memory and language impairments lead to syntactic and semantic errors. However, conventional speech-processing pipelines with hand-crafted features or general-purpose audio classifiers often exhibit limited performance and generalizability. To address these limitations, we introduce SpeechCARE, a multimodal speech processing pipeline that leverages pretrained, multilingual acoustic and linguistic transformer models to capture subtle speech-related cues associated with cognitive impairment. Inspired by the Mixture of Experts (MoE) paradigm, SpeechCARE employs a dynamic fusion architecture that weights transformer-based acoustic, linguistic, and demographic inputs, allowing integration of additional modalities (e.g., social factors, imaging) and enhancing robustness across diverse tasks. Its robust preprocessing includes automatic transcription, large language model (LLM)-based anomaly detection, and task identification. A SHAP-based explainability module and LLM reasoning highlight each modality's contribution to decision-making. SpeechCARE achieved AUC = 0.88 and F1 = 0.72 for classifying cognitively healthy, MCI, and AD individuals, with AUC = 0.90 and F1 = 0.62 for MCI detection. Bias analysis showed minimal disparities, except for adults over 80. Mitigation techniques included oversampling and weighted loss. Future work includes deployment in real-world care settings (e.g., VNS Health, Columbia ADRC) and EHR-integrated explainability for underrepresented populations in New York City.

Fatemeh Taherinezhad, Mohamad Javad Momeni Nezhad, Sepehr Karimi et al.

Over half of US adults with Alzheimer disease and related dementias remain undiagnosed, and speech-based screening offers a scalable detection approach. We compared large language model adaptation strategies for dementia detection using the DementiaBank speech corpus, evaluating nine text-only models and three multimodal audio-text models on recordings from DementiaBank speech corpus. Adaptations included in-context learning with different demonstration selection policies, reasoning-augmented prompting, parameter-efficient fine-tuning, and multimodal integration. Results showed that class-centroid demonstrations achieved the highest in-context learning performance, reasoning improved smaller models, and token-level fine-tuning generally produced the best scores. Adding a classification head substantially improved underperforming models. Among multimodal models, fine-tuned audio-text systems performed well but did not surpass the top text-only models. These findings highlight that model adaptation strategies, including demonstration selection, reasoning design, and tuning method, critically influence speech-based dementia detection, and that properly adapted open-weight models can match or exceed commercial systems.

Ali Zolnour, Hossein Azadmaleki, Yasaman Haghbin et al.

Alzheimer's disease and related dementias(ADRD) affect nearly five million older adults in the United States, yet more than half remain undiagnosed. Speech-based natural language processing(NLP) offers a scalable approach for detecting early cognitive decline through subtle linguistic markers that may precede clinical diagnosis. This study develops and evaluates a speech-based screening pipeline integrating transformer embeddings with handcrafted linguistic features, synthetic augmentation using large language models(LLMs), and benchmarking of unimodal and multimodal classifiers. External validation assessed generalizability to a MCI-only cohort. Transcripts were drawn from the ADReSSo 2021 benchmark dataset(n=237, Pitt Corpus) and the DementiaBank Delaware corpus(n=205, MCI vs. controls). Ten transformer models were tested under three fine-tuning strategies. A late-fusion model combined embeddings from the top transformer with 110 linguistic features. Five LLMs(LLaMA8B/70B, MedAlpaca7B, Ministral8B,GPT-4o) generated label-conditioned synthetic speech for augmentation, and three multimodal LLMs(GPT-4o,Qwen-Omni,Phi-4) were evaluated in zero-shot and fine-tuned modes. On ADReSSo, the fusion model achieved F1=83.3(AUC=89.5), outperforming transformer-only and linguistic baselines. MedAlpaca7B augmentation(2x) improved F1=85.7, though larger scales reduced gains. Fine-tuning boosted unimodal LLMs(MedAlpaca7B F1=47.7=>78.7), while multimodal models performed lower (Phi-4=71.6;GPT-4o=67.6). On Delaware, the fusion plus 1x MedAlpaca7B model achieved F1=72.8(AUC=69.6). Integrating transformer and linguistic features enhances ADRD detection. LLM-based augmentation improves data efficiency but yields diminishing returns, while current multimodal models remain limited. Validation on an independent MCI cohort supports the pipeline's potential for scalable, clinically relevant early screening.