Acoustic biomarkers show promise for detecting Alzheimer's Disease (AD), yet whether the cues driving diagnostic AI align with those salient to human listeners is underexplored across languages and genders, where pathological markers and perceptual strategies differ. We train models to predict clinical AD status (pathology) and human perceptual scores across Mandarin and Greek, male and female speakers. Using SHAP for interpretability and statistical models for validation, we compare feature importance by subgroup. Results reveal a context-dependent divergence: pathological-perceptual alignment is significant for Mandarin and female speakers but disappears for Greek and male speakers, where pathology models did not exceed chance; this is a failure mode that population-specific auditing surfaces. Global Explainable AI (XAI) explanations can mask critical demographic divergences, highlighting the need for population-specific explainability auditing for equitable deployment of clinical speech AI.
Speech-based Alzheimer's disease (AD) detection increasingly relies on speech-enhanced and curated versions of the Pitt Corpus, where speech enhancement, sample selection, and demographic balancing are often treated as beneficial preprocessing steps. However, whether these transformations improve real-world AD detection or instead affect model generalization and prediction behavior remains unclear. In this work, we revisit the role of speech preprocessing and dataset curation across widely used benchmarks for speech-based AD detection. We evaluate the speech quality of different datasets, the cross-dataset generalization of multiple deep learning models under matched and mismatched enhancement settings, and the behavior of several recent large audio-language models (LALMs). Experimental results show that across multiple supervised speech models, speech-enhanced datasets often improve in-domain performance while reducing robustness in cross-domain evaluation. Matched enhancement between training and test data alleviates, but does not eliminate, this degradation. LALMs show a similar sensitivity: enhanced datasets induce stronger class imbalance and prediction shifts than unprocessed data. These results suggest that speech preprocessing and dataset curation can substantially influence downstream AD detection behavior, indicating that ``cleaner'' speech datasets are not necessarily more reliable for real-world AD detection.
Identifying reliable Alzheimer's disease (AD) markers typically requires manual, labor-intensive transcription and expert analysis, limiting its scale. We introduce an automated pipeline that extracts qualitative knowledge about potential AD progression indicators directly from audio recordings of verbal fluency tests. Our method uses pretrained foundation models to process raw audio and extract clinically relevant variables to construct a Bayesian Network (BN); this BN is used to reason about the AD progression markers and infer their qualitative relationships. Our system successfully recovers known clinical knowledge and identifies novel relationships between linguistic markers.
Speech technology penalizes some voices: recognition errs nearly twice as often for Black speakers, and accuracy declines for second-language accents and older speakers. We introduce TRIAD, an audit grid crossing 120 texts, 24 rendered demographic voice profiles (gender, age band, accent), and ten expressive styles via controllable text-to-speech, isolating perceived demographic attributes from content and affect. For ten open-weights encoders we define axis-fidelity functionals, principal-angle leakage between axis subspaces, and group-conditional gaps; a proposition proves that average probe disparity grows with the same aggregate voice-semantic leakage Λ we measure, and a corollary shows that peak leakage forces worst-case disparity inside an active region. The measured mean-square probe disparity tracks Λ (Pearson r = 0.93), and a black-box protocol exposes the same signature in two closed-source models. ORCA, an adapter combining axis-specific contrastive heads, an orthogonality penalty, and group-balanced sampling, cuts leakage 72% and roughly halves the gaps.