PROCESS-2: A Benchmark Speech Corpus for Early Cognitive Impairment Detection

\noindent\textbf{Background 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\noindent\textbf{Methods:} 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\noindent\textbf{Results:} 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\noindent\textbf{Conclusions:} 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.

Early detection of cognitive decline from speech offers a scalable and non-invasive alternative to conventional clinical assessment. Verbal fluency tasks are particularly informative, but most automated approaches aggregate features across an entire recording, overlooking temporal speech dynamics. We propose the Cognitive Instability-Aware Cross-Modal Attention Network (CCMAN), a transfer learning framework that learns task-agnostic cognitive speech representations from multiple memory-probing tasks before fine-tuning on a minute-long semantic and phonemic verbal fluency task. CCMAN integrates semantic, acoustic, and linguistic information through bidirectional cross-attention, gated multimodal fusion, and transformer-based temporal modelling to derive interpretable biomarkers of cognitive decline. Experiments were conducted on 165.44 hours of speech from 843 participants (498 healthy controls, 245 with mild cognitive impairment, and 100 with dementia). CCMAN achieved Macro-F1 scores of 0.81 and 0.59 for binary and multiclass semantic fluency classification, and 0.77 and 0.53 for phonemic fluency, consistently outperforming strong static and temporal baselines. Statistical analyses showed that semantic drift variance and pause variance, but not mean semantic drift, were significantly elevated in both MCI and dementia relative to healthy controls, while pause duration increased progressively over the task with the steepest slope in dementia, supporting global and progressive temporal speech instability as interpretable biomarkers. Evaluation on the independent PROCESS-2 benchmark further demonstrated the generalisability of the proposed framework, improving the baseline Macro-F1 by up to 9%. These findings support temporal speech instability as a dynamic speech biomarker for robust, interpretable, and generalisable early detection of cognitive decline.