Megan A. Witherow, Michael L. Evans, Ahmed Temtam et al.
Alzheimer's disease (AD), defined as an abnormal buildup of amyloid plaques and tau tangles in the brain can be diagnosed with high accuracy based on protein biomarkers via PET or CSF analysis. However, due to the invasive nature of biomarker collection, most AD diagnoses are made in memory clinics using cognitive tests and evaluation of hippocampal atrophy based on MRI. While clinical assessment and hippocampal volume show high diagnostic accuracy for amnestic or typical AD (tAD), a substantial subgroup of AD patients with atypical presentation (atAD) are routinely misdiagnosed. To improve diagnosis of atAD patients, we propose a machine learning approach to distinguish between atAD and non-AD cognitive impairment using clinical testing battery and MRI data collected as standard-of-care. We develop and evaluate our approach using 1410 subjects across four groups (273 tAD, 184 atAD, 235 non-AD, and 685 cognitively normal) collected from one private data set and two public data sets from the National Alzheimer's Coordinating Center (NACC) and the Alzheimer's Disease Neuroimaging Initiative (ADNI). We perform multiple atAD vs. non-AD classification experiments using clinical features and hippocampal volume as well as a comprehensive set of MRI features from across the brain. The best performance is achieved by incorporating additional important MRI features, which outperforms using hippocampal volume alone. Furthermore, we use the Boruta statistical approach to identify and visualize significant brain regions distinguishing between diagnostic groups. Our ML approach improves the percentage of correctly diagnosed atAD cases (the recall) from 52% to 69% for NACC and from 34% to 77% for ADNI, while achieving high precision. The proposed approach has important implications for improving diagnostic accuracy for non-amnestic atAD in clinical settings using only clinical testing battery and MRI.