Automatic estimation of verbal fluency index in people with Motor Neuron Disease using ASR alignment and pause modelling

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.

Early detection of cognitive impairment relies on neuropsychological tests to minimize subjectivity by assessing multiple cognitive domains. Speech-based evaluation can support diagnostics and improve accessibility, but transcription errors and the omission of nonverbal subtests (e.g., motor skills) limit accuracy. Beyond conventional test scores, speech-derived features can provide additional insights into cognitive status. This study investigates the speech-based evaluation of the German "Syndrom-Kurz-Test," a standardized dementia screening test comprising verbal and motor subtests. We train models that integrate transcript-derived scores and Whisper embeddings per verbal subtest to reduce scoring errors. To compensate for missing motor subtests, we then leverage these fused representations to approximate expert overall ratings. Despite omitting subtests, our models strongly correlate with expert ratings and efficiently and accurately discriminate between cognitive status groups.

Recent advances in Artificial Intelligence (AI) and the exploration of noninvasive, objective biomarkers, such as speech signals, have encouraged the development of algorithms to support the early diagnosis of neurodegenerative diseases, including Amyotrophic Lateral Sclerosis (ALS). Voice changes in subjects suffering from ALS typically manifest as progressive dysarthria, which is a prominent neurodegenerative symptom because it affects patients as the disease progresses. Since voice signals are complex data, the development and use of advanced AI techniques are fundamental to extracting distinctive patterns from them. Validating AI algorithms for ALS diagnosis and monitoring using voice signals is challenging, particularly due to the lack of annotated reference datasets. In this work, we present the outcome of a collaboration between a multidisciplinary team of clinicians and Machine Learning experts to create both a clinically annotated validation dataset and the "Speech Analysis for Neurodegenerative Diseases" (SAND) challenge based on it. Specifically, by analyzing voice disorders, the SAND challenge provides an opportunity to develop, test, and evaluate AI models for the automatic early identification and prediction of ALS disease progression.