Deborah Blacker

Jiazi Tian, Liqin Wang, Pedram Fard et al.

Early identification of cognitive concerns is critical but often hindered by subtle symptom presentation. This study developed and validated a fully automated, multi-agent AI workflow using LLaMA 3 8B to identify cognitive concerns in 3,338 clinical notes from Mass General Brigham. The agentic workflow, leveraging task-specific agents that dynamically collaborate to extract meaningful insights from clinical notes, was compared to an expert-driven benchmark. Both workflows achieved high classification performance, with F1-scores of 0.90 and 0.91, respectively. The agentic workflow demonstrated improved specificity (1.00) and achieved prompt refinement in fewer iterations. Although both workflows showed reduced performance on validation data, the agentic workflow maintained perfect specificity. These findings highlight the potential of fully automated multi-agent AI workflows to achieve expert-level accuracy with greater efficiency, offering a scalable and cost-effective solution for detecting cognitive concerns in clinical settings.

Yu Leng, Yingnan He, Colin Magdamo et al.

Identifying cognitive impairment within electronic health records (EHRs) is crucial not only for timely diagnoses but also for facilitating research. Information about cognitive impairment often exists within unstructured clinician notes in EHRs, but manual chart reviews are both time-consuming and error-prone. To address this issue, our study evaluates an automated approach using zero-shot GPT-4o to determine stage of cognitive impairment in two different tasks. First, we evaluated the ability of GPT-4o to determine the global Clinical Dementia Rating (CDR) on specialist notes from 769 patients who visited the memory clinic at Massachusetts General Hospital (MGH), and achieved a weighted kappa score of 0.83. Second, we assessed GPT-4o's ability to differentiate between normal cognition, mild cognitive impairment (MCI), and dementia on all notes in a 3-year window from 860 Medicare patients. GPT-4o attained a weighted kappa score of 0.91 in comparison to specialist chart reviews and 0.96 on cases that the clinical adjudicators rated with high confidence. Our findings demonstrate GPT-4o's potential as a scalable chart review tool for creating research datasets and assisting diagnosis in clinical settings in the future.

Tanish Tyagi, Colin G. Magdamo, Ayush Noori et al.

Dementia related cognitive impairment (CI) is a neurodegenerative disorder, affecting over 55 million people worldwide and growing rapidly at the rate of one new case every 3 seconds. 75% cases go undiagnosed globally with up to 90% in low-and-middle-income countries, leading to an estimated annual worldwide cost of USD 1.3 trillion, forecasted to reach 2.8 trillion by 2030. With no cure, a recurring failure of clinical trials, and a lack of early diagnosis, the mortality rate is 100%. Information in electronic health records (EHR) can provide vital clues for early detection of CI, but a manual review by experts is tedious and error prone. Several computational methods have been proposed, however, they lack an enhanced understanding of the linguistic context in complex language structures of EHR. Therefore, I propose a novel and more accurate framework, NeuraHealth, to identify patients who had no earlier diagnosis. In NeuraHealth, using patient EHR from Mass General Brigham BioBank, I fine-tuned a bi-directional attention-based deep learning natural language processing model to classify sequences. The sequence predictions were used to generate structured features as input for a patient level regularized logistic regression model. This two-step framework creates high dimensionality, outperforming all existing state-of-the-art computational methods as well as clinical methods. Further, I integrate the models into a real-world product, a web app, to create an automated EHR screening pipeline for scalable and high-speed discovery of undetected CI in EHR, making early diagnosis viable in medical facilities and in regions with scarce health services.

Tanish Tyagi, Colin G. Magdamo, Ayush Noori et al.

Dementia is a neurodegenerative disorder that causes cognitive decline and affects more than 50 million people worldwide. Dementia is under-diagnosed by healthcare professionals - only one in four people who suffer from dementia are diagnosed. Even when a diagnosis is made, it may not be entered as a structured International Classification of Diseases (ICD) diagnosis code in a patient's charts. Information relevant to cognitive impairment (CI) is often found within electronic health records (EHR), but manual review of clinician notes by experts is both time consuming and often prone to errors. Automated mining of these notes presents an opportunity to label patients with cognitive impairment in EHR data. We developed natural language processing (NLP) tools to identify patients with cognitive impairment and demonstrate that linguistic context enhances performance for the cognitive impairment classification task. We fine-tuned our attention based deep learning model, which can learn from complex language structures, and substantially improved accuracy (0.93) relative to a baseline NLP model (0.84). Further, we show that deep learning NLP can successfully identify dementia patients without dementia-related ICD codes or medications.

Zhuoqiao Hong, Colin G. Magdamo, Yi-han Sheu et al.

Dementia is under-recognized in the community, under-diagnosed by healthcare professionals, and under-coded in claims data. Information on cognitive dysfunction, however, is often found in unstructured clinician notes within medical records but manual review by experts is time consuming and often prone to errors. Automated mining of these notes presents a potential opportunity to label patients with cognitive concerns who could benefit from an evaluation or be referred to specialist care. In order to identify patients with cognitive concerns in electronic medical records, we applied natural language processing (NLP) algorithms and compared model performance to a baseline model that used structured diagnosis codes and medication data only. An attention-based deep learning model outperformed the baseline model and other simpler models.