Concentrated Causal Influence, Distributed Diagnostic Information: Cognitive Impairment Decisions in Large Audio-Language Models
Organizations: Center for Language and Speech Processing (CLSP), Johns Hopkins University, USA · Group on Language, Audio & Music (GLAM), Imperial College London, UK
Abstract
Large audio-language models (LALMs) can assess cognitive impairment (CI) from speech, yet their answers reveal neither which internal components control the decision nor how much CI information is accessible in their representations. We investigate both questions through CI-contrast neurons (CICNs), selected by class-contrastive activation frequency in decoder MLPs. Across eight open LALMs and two corpora (Pitt and PROCESS-2), we causally test CICNs against size- and layer-matched random masks and activity-matched controls. In three of the five models that meet our eligibility criteria, ablation of small CICN sets causes large, class-directed prediction shifts; speech-identified masks also control transcript-only decisions, and three of four primary Pitt masks retain specificity on PROCESS-2. Position-restricted interventions locate the influence before the final answer position, most strongly after the speech or transcript evidence under letter-labeled options, largely as a decision-direction shift. Beyond causal localization, supervised linear readouts of frozen CICN activations achieve 0.92--0.97 AUC within Pitt, versus 0.67--0.84 for the models' direct answers. Matched random and all-neuron readouts reach comparable performance; top-ranked CICNs show only an exploratory advantage at very small unit budgets. These results distinguish concentrated causal control over output decisions from broadly distributed diagnostic information for CI detection in LALMs.
Figures & tables
| AUC | Spearman | offset | ||||||
|---|---|---|---|---|---|---|---|---|
| Model | Cond. | Mask | real | random | real | random | share | |
| Kimi-Audio | AT-chat | NC | 0.059 | +0.002 0.019 | 0.009 | 0.925 | 0.968 | 0.91 |
| MiniCPM-o-4.5 | A | CI | 0.040 | 0.003 0.010 | 0.003 | 0.953 | 0.989 | 0.89 |
| MiniCPM-o-4.5 | AT | CI | +0.001 | +0.003 0.009 | 0.95 | 0.964 | 0.986 | 0.89 |
| Qwen3-Omni-30B | AT | NC | 0.000 | 0.000 0.009 | 0.95 | 0.935 | 0.981 | 0.61 |
| Kimi-Audio | A | NC | 0.023 | +0.004 0.017 | 0.16 | 0.896 | 0.967 | 0.69 |
| evaluated under | |||||||
|---|---|---|---|---|---|---|---|
| Model | Mask | identified | T | T random | A | AT | AT-chat |
| Kimi-Audio | NC | A | +0.164 ∗ | 0.003 0.055 | +0.139 | +0.131 | +0.144 |
| AT | +0.258 ∗ | +0.008 0.042 | +0.230 | +0.228 | +0.146 | ||
| AT-chat | +0.246 ∗ | +0.036 0.044 | +0.266 | +0.240 | +0.267 | ||
| MiniCPM-o-4.5 | CI | A | 0.178 ∗ | +0.012 0.042 | 0.212 | 0.202 | 0.118 |
| AT | 0.237 ∗ | +0.017 0.044 | 0.221 | 0.253 | 0.109 | ||
Appendix figures & tables27 assets
Supplementary material from the paper’s appendix.
Appendix
| Model | Hugging Face checkpoint |
|---|---|
| Qwen2.5-Omni-7B | Qwen/Qwen2.5-Omni-7B |
| Qwen3-Omni-30B | Qwen/Qwen3-Omni-30B-A3B-Instruct |
| Kimi-Audio | moonshotai/Kimi-Audio-7B-Instruct |
| MiniCPM-o-4.5 | openbmb/MiniCPM-o-4_5 |
| Gemma-4-12B | google/gemma-4-12B-it |
| Voxtral-Small-24B | mistralai/Voxtral-Small-24B-2507 |
| Model | Layers | MLP width | Neurons | Mask ( ) |
|---|---|---|---|---|
| Qwen2.5-Omni-7B | 28 | 18,944 | 530,432 | 2,652 |
| Qwen3-Omni-30B | 48 | 4,718,592 | 23,592 | |
| Kimi-Audio | 28 | 18,944 | 530,432 | 2,652 |
| MiniCPM-o-4.5 | 36 | 12,288 | 442,368 | 2,211 |
| Gemma-4-12B | 48 | 15,360 | 737,280 | 3,686 |
| eval. | identification | ||
|---|---|---|---|
| Model | Cond. | UAR | UAR [95% CI] |
| Gemma-4-12B | AT | 0.67 | 0.663 [0.608, 0.715] |
| AT-chat | 0.68 | 0.639 [0.582, 0.695] | |
| Kimi-Audio | A | 0.67 | 0.634 [0.573, 0.690] |
| AT | 0.64 | 0.615 [0.554, 0.673] | |
| AT-chat | 0.64 | 0.589 [0.528, 0.652] |
| HC | MCI | Dementia | |
| Labeled style ( ) | 99 | 124 | 38 |
| Plain style ( ) | 101 | 26 | 12 |
| Plain style (%) | 50.5 | 17.3 | 24.0 |
| Fillers / 100 words, labeled | 3.9 | 3.7 | 2.8 |
| Fillers / 100 words, plain | 1.4 | 2.8 | 3.7 |
| Median words, labeled | 163 | 127 | 120 |
| CHAT | Rendered as |
|---|---|
| (.) , (..) , (...) | (short pause), (pause), (long pause) |
| timed pause (2.5) | (pause 2.5s) |
| filler &-uh | uh |
| fragment &+wa | wa- |
| [/] , [//] , [///] | [repeats], [self-correction], [reformulation] |
| [/-] , [/?] | [false start], [unclear retracing] |
| Analysis | Null | Family | |
|---|---|---|---|
| Ablation, own condition (§ 5.1 ) | matched random masks | 20 | 24 masks |
| Ablation, own condition (§ 5.1 ) | sets matched on activation statistics | 20 | 8 masks |
| Ablation, transfer to T (§ 5.3 ) | matched random masks under T | 20 | 24 masks |
| Class-mean shift (§ 5.1 ) | norm-matched random masks | 20 | 21 mask– cells |
| CICN masks on gender (§ 5.1 ) | matched random masks | 20 | cross-task, only |
| Span masks (App. F.1 ) | matched random masks | 20 | 36 masks |
| Model | Cond. | UAR | 95% CI | F1 | pred. CI | |
|---|---|---|---|---|---|---|
| Qwen2.5-Omni-7B | T | 0.664 | [0.580, 0.751] | 0.634 | 0.464 | 0.430 |
| A | 0.587 | [0.527, 0.644] | 0.471 | 0.342 | 0.159 | |
| AT | 0.736 | [0.646, 0.817] | 0.715 | 0.492 | 0.495 | |
| AT-chat | 0.582 | [0.542, 0.629] | 0.435 | 0.377 | 0.103 | |
| Qwen3-Omni-30B | T | 0.736 | [0.668, 0.806] | 0.682 | 0.343 | 0.346 |
| A | 0.726 | [0.636, 0.808] | 0.699 | 0.432 | 0.458 |
| Model | Cond. | UAR | 95% CI | F1 | pred. CI | |
|---|---|---|---|---|---|---|
| Qwen2.5-Omni-7B | T | 0.549 | [0.468, 0.652] | 0.553 | 0.330 | 0.121 |
| A | 0.568 | [0.480, 0.665] | 0.576 | 0.310 | 0.091 | |
| AT | 0.606 | [0.506, 0.719] | 0.618 | 0.369 | 0.131 | |
| Qwen3-Omni-30B | T | 0.487 | [0.467, 0.500] | 0.438 | 0.077 | 0.020 |
| A | 0.525 | [0.500, 0.583] | 0.494 | 0.086 | 0.010 | |
| AT | 0.562 | [0.494, 0.661] | 0.565 | 0.166 | 0.051 |
| T | A | AT | ||||
|---|---|---|---|---|---|---|
| Model | lab. | plain | lab. | plain | lab. | plain |
| Qwen2.5-Omni-7B | 0.59 | 0.51 | 0.56 | 0.58 | 0.67 | 0.44 |
| Qwen3-Omni-30B | 0.47 | 0.50 | 0.50 | 0.60 | 0.54 | 0.60 |
| Kimi-Audio | 0.53 | 0.55 | 0.66 | 0.59 | 0.70 | 0.53 |
| MiniCPM-o-4.5 | 0.62 | 0.56 | 0.67 | 0.44 | 0.61 | 0.48 |
| Gemma-4-12B | 0.71 | 0.73 | 0.57 | 0.43 | 0.47 | 0.61 |
| Pitt | PROCESS-2 | ||||
|---|---|---|---|---|---|
| Model | AT T | AT A | chat AT | AT T | AT A |
| Qwen2.5-Omni-7B | +0.07 | +0.15 ∗ | 0.15 ∗ | +0.06 | +0.04 |
| Qwen3-Omni-30B | +0.01 | +0.02 | +0.00 | +0.08 | +0.04 |
| Kimi-Audio | +0.01 | 0.04 | +0.00 | +0.13 | +0.01 |
| MiniCPM-o-4.5 | +0.09 | 0.03 | +0.03 | 0.03 | 0.04 |
| Gemma-4-12B | +0.10 | +0.07 | +0.02 | 0.20 ∗ | 0.02 |
| eligible / total | tokens pooled ( ) | ||||
| Model | Cond. | NC | CI | NC | CI |
| Pitt | |||||
| Qwen2.5-Omni-7B | AT | 24 / 152 | 16 / 145 | 42,988 | 61,434 |
| Qwen3-Omni-30B | A | 64 / 152 | 20 / 145 | 21,960 | 23,438 |
| AT | 47 / 152 | 46 / 145 | 23,286 | 28,064 | |
| AT-chat | 73 / 152 | 19 / 145 | 25,008 | 36,058 | |
| Activity-matched sets | Prompt variants, | |||||||
|---|---|---|---|---|---|---|---|---|
| Model | Cond. | Mask | real | sets | paraphrase | numeric labels | ||
| Qwen3-Omni-30B | AT | NC | +1.77 | 0.16 0.76 | 0.030 | 0.040 | 0.001 | 0.001 |
| MiniCPM-o-4.5 | A | CI | 2.51 | 0.27 0.95 | 0.033 | 0.040 | 0.001 | 0.006 |
| MiniCPM-o-4.5 | AT | CI | 2.63 | 0.64 0.86 | 0.035 | 0.040 | 0.001 | 0.002 |
| Kimi-Audio | AT-chat | NC | +1.60 | +0.05 0.60 | 0.033 | 0.040 | 0.006 | 0.005 |
| Kimi-Audio | AT | NC | +1.46 | 0.05 0.56 | 0.020 | 0.040 | – | – |
| main | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model | Cond. | Mask | flip | flip | flip | flip | flip | |||||
| Kimi-Audio | A | NC | +0.139 | 0.50 § | +0.125 | 0.63 | +0.105 | 0.42 | +0.011 | 0.17 | +0.220 | 0.79 § |
| Kimi-Audio | AT | NC | +0.228 | 0.95 § | +0.164 | 0.57 | +0.132 | 0.67 § | +0.046 | 0.33 § | +0.262 | 1.00 § |
| Kimi-Audio | AT-chat | NC | +0.267 | 0.88 § | +0.250 | 0.88 § | +0.207 | 0.77 § | +0.152 | 0.58 § | +0.064 | 0.35 |
| MiniCPM-o-4.5 | A | CI | 0.212 | 0.38 § | 0.105 | 0.12 § | 0.189 | 0.36 § | 0.105 | 0.14 § | 0.203 | 0.41 § |
| MiniCPM-o-4.5 | AT | CI | 0.253 | 0.55 § | 0.355 | 0.68 § | 0.133 | 0.23 | 0.087 | 0.16 | 0.268 | 0.68 § |
| pool (30) | all identification (297) | |||||||
|---|---|---|---|---|---|---|---|---|
| Model | Cond. | Mask | raw | adjusted | kept | raw | adjusted | kept |
| Kimi-Audio | A | NC | 0.127 | 0.086 | 68% | 0.051 | 0.033 | 65% |
| Kimi-Audio | AT | NC | 0.092 | 0.080 | 86% | 0.046 | 0.042 | 91% |
| Kimi-Audio | AT-chat | NC | 0.094 | 0.069 | 73% | 0.039 | 0.032 | 82% |
| MiniCPM-o-4.5 | A | CI | 0.139 | 0.080 | 58% | 0.056 | 0.035 | 61% |
| MiniCPM-o-4.5 | AT | CI | 0.119 | 0.078 | 66% | 0.054 | 0.035 | 64% |
| CICN mask gender | gender mask CI | |||
|---|---|---|---|---|
| CICN cell (own on CI) | real | random | male | female |
| Qwen3 AT NC (1.87) | 0.62 | 0.49 0.08 | 0.87 (0.65 0.09) | 0.97 (0.70 0.15) |
| Qwen3 AT CI (1.10) | 1.61 ∗ | 0.48 0.05 | (same cell as above) | |
| Kimi AT NC (1.46) | 0.21 | 0.22 0.08 | 0.89 ∗ (0.40 0.12) | 0.35 (0.41 0.17) |
| Kimi AT-chat NC (1.60) | 0.23 | 0.21 0.05 | 0.89 (0.42 0.21) | 0.30 (0.57 0.28) |
| MiniCPM A CI (2.51) | 1.35 ∗ | 0.57 0.27 | 0.42 (0.52 0.25) | 0.47 (0.44 0.20) |
| Model / cond. / mask | real | norm-m. | real | norm-m. | real | norm-m. | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Kimi AT NC | +0.197 | 0.010 | 0.007 | +1.27 | 0.06 | 0.006 | 0.072 | 0.90 § | 0.13 | |
| Kimi AT NC | 0.148 | +0.020 | 0.024 | 0.91 | +0.12 | 0.027 | 0.094 | 0.20 § | 0.03 | |
| Kimi AT-chat NC | +0.225 | +0.002 | 0.010 | +1.25 | +0.01 | 0.007 | 0.072 | 0.77 § | 0.14 | |
| Kimi AT-chat NC | 0.059 | +0.002 | 0.013 | 0.31 | 0.00 | 0.013 | 0.072 | 0.14 § | 0.02 | |
| Kimi AT-chat NC | 0.220 | +0.001 | 0.017 | 1.23 | 0.01 | 0.015 | 0.072 | 0.57 § | 0.09 | |
| Model | Mask | A – AT | A – AT-chat | AT – AT-chat |
|---|---|---|---|---|
| Qwen3-Omni-30B | NC | 0.28 | 0.32 | 0.42 |
| CI | 0.19 | 0.57 | 0.29 | |
| Kimi-Audio | NC | 0.19 | 0.20 | 0.30 |
| CI | 0.20 | 0.28 | 0.30 | |
| MiniCPM-o-4.5 | NC | 0.33 | 0.24 | 0.21 |
| CI | 0.40 | 0.24 | 0.22 |
| evaluated under | ||||
| Model (NC mask) | span | T | A | AT |
| Kimi-Audio | audio | +0.27 ∗ (4.5) | +0.29 ∗ (3.3) | +0.27 ∗ (2.9) |
| audio (tok.-matched) | +0.28 ∗ (4.7) | +0.34 ∗ (5.4) | +0.28 ∗ (3.8) | |
| text | 0.04 ( 1.4) | 0.07 ( 1.3) | 0.02 ( 0.3) | |
| Qwen3-Omni-30B | audio | +0.31 ∗ (9.1) | +0.16 ∗ (5.5) | +0.17 ∗ (6.1) |
| audio (tok.-matched) | +0.19 ∗ (4.1) | +0.08 (1.7) | +0.09 ∗ (2.6) | |
| Model | Cond. | Mask | real | random | real | random | ( ) | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Kimi-Audio | AT | NC | +0.298 | +0.002 | 0.001 | +1.72 | 0.01 | 0.001 | 0.006 | 0.65 (65) |
| MiniCPM-o-4.5 | A | CI | 0.143 | +0.018 | 0.001 | 2.26 | +0.14 | 0.001 | 0.006 | – (7) |
| Qwen3-Omni-30B | A | NC | +0.112 | +0.019 | 0.001 | +1.85 | +0.27 | 0.001 | 0.006 | 0.06 (79) |
| Qwen3-Omni-30B | AT | NC | +0.110 | +0.015 | 0.001 | +1.91 | +0.21 | 0.001 | 0.006 | 0.14 (77) |
| Kimi-Audio | A | NC | +0.202 | 0.008 | 0.002 | +1.15 | 0.10 | 0.010 | 0.033 | 0.29 (75) |
| Model | Cond. | Mask | lab. | plain | lab. | plain |
|---|---|---|---|---|---|---|
| Pitt masks | ||||||
| Kimi-Audio | A | NC | +0.202 ( 0.013) | +0.203 ( 0.002) | 0.28 (0.03) | 0.31 (0.04) |
| Kimi-Audio | AT | NC | +0.282 ( 0.001) | +0.317 (+0.006) | 0.65 (0.06) | 0.65 (0.06) |
| Kimi-Audio | AT-chat AT | NC | +0.291 (+0.037) | +0.309 (+0.043) | 0.71 (0.09) | 0.59 (0.11) |
| MiniCPM-o-4.5 | A | CI | 0.145 (+0.015) | 0.142 (+0.022) | – | – |
| Model | Cond. | Mask | real | random | real | random | |||
|---|---|---|---|---|---|---|---|---|---|
| Pitt held-out (16 MCI, 4 vascular, 3 other) | |||||||||
| Kimi-Audio | A | NC | +0.200 | 0.027 0.085 | 0.018 | +1.09 | 0.17 | 0.026 | 0.034 |
| Kimi-Audio | AT | NC | +0.301 | 0.002 0.068 | 0.001 | +1.84 | 0.03 | 0.001 | 0.001 |
| Kimi-Audio | AT-chat | NC | +0.290 | +0.021 0.056 | 0.001 | +1.75 | +0.11 | 0.001 | 0.001 |
| MiniCPM-o-4.5 | A | CI | 0.203 | +0.016 0.054 | 0.001 | 2.20 | +0.17 | 0.002 | 0.003 |
| Kimi-Audio AT NC | Kimi-Audio AT-chat NC | MiniCPM-o-4.5 A CI | MiniCPM-o-4.5 AT CI | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Ablated positions | orig. | orig. | para. | num. | orig. | para. | num. | orig. | para. | num. |
| all (Figure 1 ) | +0.228 ∗ | +0.267 ∗ | – | – | 0.212 ∗ | – | – | 0.253 ∗ | – | – |
| all but the last | +0.222 ∗ | +0.252 ∗ | +0.179 ∗ | +0.223 ∗ | 0.217 ∗ | 0.324 ∗ | 0.135 ∗ | 0.261 ∗ | 0.330 ∗ | 0.218 ∗ |
| audio span | +0.069 ∗ | +0.038 | +0.030 | +0.041 | 0.100 ∗ | 0.109 ∗ | 0.085 ∗ | 0.084 ∗ | 0.083 ∗ | 0.083 ∗ |
| transcript span | +0.022 ∗ | +0.016 | – | – | – | – | – | 0.034 ∗ | – | – |
| template | +0.152 ∗ | +0.227 ∗ | – | – | 0.123 ∗ | – | – | 0.161 ∗ | – | – |
| Kimi-Audio | MiniCPM-o-4.5 | ||||
|---|---|---|---|---|---|
| Contrast | Mask | AT | AT-chat | AT | AT-chat |
| info. unit content | CI | 0.055 ∗ ( 0.008) | 0.047 ∗ ( 0.008) | 0.128 ∗ ( 0.039) | 0.128 ∗ ( 0.036) |
| NC | 0.039 ∗ ( 0.010) | 0.056 ∗ ( 0.015) | 0.076 ∗ ( 0.036) | 0.076 ∗ ( 0.032) | |
| filler content | CI | – | +0.185 ∗ (+0.058) | – | +0.332 ∗ (+0.088) |
| fragment content | CI | – | +0.210 ∗ (+0.088) | – | +0.350 ∗ (+0.103) |
| pause content | CI | – | +0.070 ∗ (+0.001) | – | +0.244 ∗ (+0.083) |
Audio-Language Models
Audio-language models connect audio and natural language for understanding, retrieval, dialogue, speech generation, and music or sound analysis.
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