Bias and Fairness in Self-Supervised Acoustic Representations for Cognitive Impairment Detection

This study examines the relationship between speech representations and the hierarchical structure of cognitive assessment in mild cognitive impairment. Utilizing 5,754 German neuropsychological assessment recordings, we evaluate six cognitive tasks across three score levels: task, domain, and global levels. We compare hand-crafted acoustic features with self-supervised learning (SSL) embeddings. Results show that although SSL representations generally outperform hand-crafted features at lower levels, this trend reverses for MCI classification. Furthermore, task-specific constraints influence performance: tasks with greater response freedom exhibit performance dilution as hierarchical levels increase, suggesting specialist'' representations, whereas the performance of highly structured tasks increases toward higher levels, suggesting generalist'' representations. These findings show links between task constraints and assessment hierarchy in automated clinical speech analysis.

\noindentBackground and Objective: Speech has emerged as a low-cost and non-invasive digital biomarker with considerable potential for cognitive impairment detection. However, limited labeled data and cross-dataset variability remain major challenges for robust speech-based screening systems. \par\noindentMethods: We developed a segment-level representation learning framework for speech-based cognitive impairment detection. Speech recordings were divided into short segments and converted into spectrogram representations. To improve robustness under limited-data conditions, offline and online augmentation strategies were combined with autoencoder-based representation learning and contrastive objectives to enhance discriminative latent representations. \par\noindentResults: Experiments conducted on four independent Mandarin Chinese speech datasets demonstrated stable and competitive performance in both binary and three-class classification tasks, with particularly notable improvements in the clinically challenging three-class setting. Ablation studies further supported the effectiveness of the proposed framework. \par\noindentConclusions: The findings suggest that segment-level speech representation learning may provide a scalable and practical approach for cognitive impairment screening in resource-constrained clinical settings.

Cognitive impairment (CI) is a growing public health concern. Early and accurate diagnosis is critical for enabling timely intervention and improving patient outcomes. Speech-based CI detection has emerged as a promising non-invasive approach, as speech signals encode both linguistic and acoustic markers associated with cognitive decline. Recent advances in large language models (LLMs) further strengthen the potential of speech-based assessment by enabling more expressive representation learning and improved generalization across diverse speakers, recording devices, and clinical environments. Moreover, multimodal learning by jointly modeling linguistic and acoustic features allows for a more comprehensive characterization of cognitive and behavioral changes related to CI, leading to more reliable detection. In this work, we propose a multimodal CI detection framework based on open-source LLMs that integrates speech audio and corresponding transcripts while preserving patient privacy. Acoustic embeddings are extracted directly from speech signals, while textual embeddings are generated from automatically transcribed speech. These modality-specific embeddings are then concatenated to create a combined feature vector and used for downstream classification, without requiring access to raw or sensitive patient data. The proposed approach is evaluated on the ADReSS20 and ADReSSo21 benchmark datasets. Experimental results show that the proposed multimodal framework achieves an CI classification accuracy of 92.4% and consistently outperforms single-modality baselines. Our work establishes a new state-of-the-art for CI identification, with the proposed method demonstrating superior cross-dataset generalization. This advance highlights the power of an LLM-based multimodal framework that fuses linguistic and acoustic data to enable robust, scalable, and non-invasive screening.