Alzheimer

Parameter-efficient fine-tuning (PEFT) has emerged as a promising paradigm for adapting pretrained models under limited data conditions. However, most existing PEFT methods are designed for matrix-structured parameters and are not well suited for high-dimensional convolutional kernels in medical imaging models. Moreover, they typically rely on additive updates and lack mechanisms to preserve the geometric structure of pretrained parameters, while multiplicative (geometry-aware) updates are difficult to integrate within a unified framework. To address this issue, this paper proposes GLT-PEFT, a gated Lie-Tucker parameter-efficient fine-tuning framework for Alzheimer's disease (AD) diagnosis. The proposed approach transfers a hippocampal segmentation pretrained model to a downstream classification task. Tucker decomposition enables tensor-aware low-rank adaptation of 3D convolutional kernels, while Lie group-based transformations provide structure-preserving multiplicative updates. A gating mechanism further reconciles additive and multiplicative update forms, resulting in a unified and more stable fine-tuning strategy. Extensive experiments demonstrate that GLT-PEFT achieves effective cross-task transfer while significantly reducing trainable parameters, highlighting its effectiveness for efficient and robust adaptation in medical imaging models.

Accurate assessment of cognitive decline from spontaneous speech remains challenging due to limited dataset size and class imbalance. In this work, we propose a large language model (LLM)-driven data augmentation framework to improve the prediction of cognitive scores from speech. Experiments are conducted on a Japanese corpus in which each participant provides both a spontaneous oral narrative and a written response to the same clinical prompt. The written responses serve as semantic anchors to generate multiple oral-like monologues in different styles using GPT-5. We then predict Hasegawa Dementia Scale scores, a widely used cognitive screening tool in Japan, using a Partial Least Squares regression model trained on Sentence-BERT speech embeddings. We investigate two augmentation strategies: random class-balanced selection, which yields moderate but unstable improvements, and similarity-guided class-balanced selection. The latter prioritizes semantically close synthetic samples, leading to more consistent improvements and substantially reducing prediction error for minority low-score participants while maintaining performance for the majority group. Overall, our findings demonstrate the potential of semantically guided LLM-driven augmentation as a principled approach for addressing class imbalance and improving data efficiency in clinical speech analysis.

The detection of Alzheimers disease (AD) is considered crucial, as timely intervention can improve patient outcomes. Electroencephalogram (EEG)-based diagnosis has been recognized as a non-invasive, accessible, and cost-effective approach for AD detection; however, it faces challenges related to data availability, accuracy of modern deep learning methods, and the time-consuming nature of expert-based interpretation. In this study, a novel lightweight and high-performance model, DeepTokenEEG, was designed for the diagnosis of AD and the classification of EEG signals from AD patients, individuals with other neurological conditions, and healthy subjects. Unlike traditional heavy-weight models, DeepTokenEEG ultilizes spatial and temporal tokenizer that effectively captures AD-related biomarkers in both temporal and frequency domain with only 0.29 million paramaters. Trained in a combined dataset of 274 subjects, including 180 AD cases, and 94 healthy controls, the proposed method achieves a maximum recorded accuracy of 100% on specific frequency bands, representing an improvement of 1.41-15.35% over state-of-the-art methods on the same dataset. These results indicate the potential of DeepTokenEEG for early detection and screening of AD, with promising applicability for deployment due to its compact size.

Speech-based analysis offers a scalable and non-invasive approach for detecting cognitive decline, yet progress has been constrained by the limited availability of clinically validated datasets collected under realistic conditions. We introduce PROCESS-2, a large-scale speech dataset designed to support research on automatic assessment of cognitive impairment from spontaneous and task-oriented speech. The dataset comprises recordings from 200 healthy controls, 150 mild cognitive impairment, and 50 dementia diagnoses collected using the CognoMemory digital assessment platform. Each participant completed a single assessment session, including picture description and verbal fluency tasks, accompanied by manually verified transcripts and participant-level metadata. PROCESS-2 contains approximately 21 hours of speech audio with predefined train/test partitions. Comprehensive technical validation evaluated demographic balance, clinical consistency, recording stability, embedding-space structure, and reproducible baseline modelling performance, demonstrating clinically meaningful group separation and stable performance across modelling approaches while preserving real-world conversational variability. PROCESS-2 is released under controlled access via Hugging Face to enable responsible reuse while protecting participant privacy, providing a reproducible benchmark resource for speech-based cognitive assessment research.

Early-stage Parkinson's disease (EarlyPD) detection from speech is clinically meaningful yet underexplored, and published results are hard to compare because studies differ in datasets, languages, tasks, evaluation protocols, and EarlyPD definitions. To address this issue, we propose the first benchmark for speech-based EarlyPD detection, with a speaker-independent split designed for fair and replicable cross-method evaluation on researcher-accessible datasets. The benchmark covers three common speech tasks and evaluates methods under different training-resource settings. We also present multi-dimensional evaluation breakdowns by dataset, aggregation level, gender, and disease stage to support fine-grained comparisons and clinical adoption. Our results provide a replicable reference and actionable insights, encouraging the adoption of this publicly available benchmark to advance robust and clinically meaningful EarlyPD detection from speech.

Missing modalities are prevalent in real-world Alzheimer's disease (AD) assessment and pose a significant challenge to multimodal learning, particularly when the distribution of observed modality subsets differs between training and deployment. Such missingness pattern mismatch induces a conditional representation shift across modality subsets. Existing approaches that rely on implicit imputation or modality synthesis often fail to explicitly model modality availability and uncertainty, leading to overconfident dependence on synthesized features, reduced robustness, and miscalibrated uncertainty estimates. To address these limitations, we propose PRA-PoE, an incomplete multimodal learning framework that is equipped with Prototype-anchored Representation Alignment (PRA) and an Uncertainty-aware Product of Experts (UA-PoE) fusion mechanism. First, PRA uses learnable global prototypes and availability-conditioned tokens to encode modality availability, distinguish observed from missing modalities, re-synthesize features for missing modalities, and adaptively refine observed representations to align latent spaces across modality subsets, with the goal of reducing representation shift under varying missingness patterns. Second, UA-PoE models each modality as a Gaussian expert and performs closed-form Product of Experts fusion, where experts with higher uncertainty are automatically down-weighted via lower precision, improving uncertainty reliability. We evaluate PRA-PoE under a clinically realistic protocol by training with naturally missing data and testing on all non-empty modality combinations. PRA-PoE consistently outperforms the state-of-the-art across datasets, achieving a 5.4% relative improvement in average accuracy on ADNI and a 10.9% relative gain in average F1 on OASIS-3 over the strongest baseline across all non-empty modality subsets.

The geometry of the retinal vessel is a key biomarker of vascular diseases, yet clinical evidence remains primarily observational. Existing generative counterfactuals intervene only at the image-level disease label, failing to isolate explicit anatomical structure. To address this limitation, we propose the Bézier Tree Encoding Counterfactual Framework (BTECF). By abstracting vascular networks into interconnected cubic-Bézier segments, BTECF establishes a disease-agnostic representation in which structural topology is explicitly preserved and atomically perturbable. Coupling this encoding with a diffusion-based generator enables parameter-level do-interventions on explicit geometric axes (e.g., tortuosity, caliber) while preserving background fundus textures. We validate BTECF on diabetic retinopathy, together with independent cohorts for ischemic stroke and Alzheimer's disease. Isolated counterfactual interventions produce dose-responsive shifts in classifier predictions; a matched pixel-drop control attenuates this response by an order of magnitude or more, ruling out out-of-distribution generation artifacts. By enforcing causal isolation between vessel topology and pixel-level confounders, BTECF provides a unified generative paradigm for hypothesis verification across systemic diseases. To support reproducibility, the code will be publicly released upon acceptance.

Vision--language models (VLMs) show promise for clinical decision support in radiology because they enable joint reasoning over radiological images and clinical text, thereby leveraging complementary clinical information. However, radiological findings are long-tailed in practice, leaving some conditions underrepresented and making zero-shot inference essential. Yet current CLIP-style medical VLMs are sensitive to prompt variations and often lack trustworthy external knowledge at inference time, which hinders reliable clinical deployment. We present \textit{KEPIL}, a prompt-robust framework that integrates curated medical knowledge to stabilize zero-shot generalization. KEPIL comprises: (i) \emph{dynamic prompt enrichment} using ontologies with LLM assistance, (ii) a \emph{semantic-aware contrastive loss} aligning embeddings of equivalent prompt variants via a dual-embedding objective, and (iii) \emph{entity-centric report standardization} to yield ontology-aligned representations. Across seven benchmarks, KEPIL achieves state-of-the-art zero-shot inference performance; under prompt-variation tests, it improves AUC by $6.37\%$ on \textit{CheXpert} and by $4.11\%$ on average. These results suggest that structured knowledge and robust prompt design are key to clinically reliable radiology-facing VLMs. Code will be released at https://github.com/Roypic/KEPIL.

Reasoning-based end-to-end (E2E) autonomous driving has recently emerged as a promising approach to improving the interpretability of driving decisions as it can generate human-readable reasoning together with predicted trajectories. Such approaches commonly generate multiple trajectories to capture diverse future behaviors, and they fall into two categories: (1) multi-reasoning, where one reasoning sequence is generated per trajectory, and (2) single-reasoning, where a single reasoning is shared across all trajectories. The former offers richer diversity at the cost of redundant computation, while the latter is more efficient but is often assumed to sacrifice diversity. Alpamayo 1, a representative system, adopts the multi-reasoning approach and achieves competitive trajectory prediction performance. However, the efficiency of this design remains largely unexplored, making it a well-motivated subject for investigation. In this paper, we systematically analyze and improve Alpamayo 1 in two ways. First, we reduce inference latency while preserving trajectory diversity by redesigning Alpamayo 1 into a single-reasoning system. Through extensive experiments, we find that replacing multi-reasoning with single-reasoning does not meaningfully degrade trajectory diversity. Second, we accelerate diffusion-based action generation by eliminating inter-block overhead arising from unnecessary copy operations and inefficient kernel execution. Through closed-loop and open-loop experiments, we validate both optimizations, demonstrating a 69.23% reduction in inference latency while maintaining trajectory diversity and prediction quality. These results highlight the importance of jointly analyzing system architecture and runtime execution to improve the efficiency of reasoning-based E2E AD systems.

Deep learning models in medical imaging typically operate as parametric memory, diagnosing patients by recalling fixed knowledge learned during training. This contrasts sharply with clinical practice, where physicians employ analogical reasoning to diagnose new cases by referencing similar records from past exemplars. While In-Context Learning (ICL) frameworks such as Tabular Prior-Fitted Networks (TabPFN) offer a promising diagnosis-by-reference paradigm, they are designed with tabular-specific inductive priors and rely on non-differentiable preprocessing pipelines, leading to manifold mismatch and gradient fracture when applied to heterogeneous multimodal data. To address these limitations, we propose PromptDx, a novel diagnosis-by-reference framework that leverages a pre-trained TabPFN as an ICL engine while enabling seamless integration with multimodal representations. Our core contribution is a Differentiable Prompt Tuning (DPT) mechanism that aligns a Masked Multimodal Modeling module with the pre-trained ICL engine. By training a lightweight adapter as a differentiable surrogate for the engine's non-differentiable preprocessors, we enable an end-to-end optimization of multimodal prompts within the ICL paradigm. We validate our method on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset using 3D MRI and tabular biomarkers. Experiments demonstrate that our approach outperforms traditional parametric baselines. Notably, our method achieves superior performance using only 1% context samples compared to 30% in standard ICL, demonstrating exceptional manifold condensation ability. We further validate the generalizability of our DPT framework across six tabular datasets with diverse scales. Overall, our method offers a more data-efficient and clinically aligned paradigm for Alzheimer's Disease diagnosis.

Individuals with Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) experience memory and thinking changes that impact their ability to use digital daily management tools. For example, adding an event to a digital calendar requires multiple steps that may act as barriers to independent use for individuals with AD/ADRD. This paper presents AI-Care, a conversational agentic artificial intelligence (AI) layer built on top of a remote caregiving platform co-designed with people with AD/ADRD. AI-Care is designed to reduce the cognitive load on individuals with AD/ADRD when managing everyday tasks such as setting calendar reminders and organizing to-do lists through natural-language interaction with a voice-first chatbot. The system uses a LangGraph-based stateful orchestration approach in which each request passes through sanitization, intent classification, context loading, safety checks, deterministic slot collection, tool execution, and response composition. Safety-critical responses, particularly around medications and allergies, are grounded in caregiver-verified records rather than free-form model generation. The system does not make autonomous medical or treatment decisions. Incomplete or ambiguous requests are handled through controlled multi-turn clarification rather than silent failure or guessing. The system supports both typed and spoken input, with voice output through ElevenLabs text-to-speech. Longer responses are chunked before synthesis to avoid rushed playback. A preliminary pilot with four individuals with mild-to-moderate AD/ADRD showed that users found the system trustworthy, competent, and likable, and were able to complete the evaluated coordination tasks through conversation. We describe the design goals, system architecture, safety controls, and findings from this formative evaluation.

Medium-horizon Alzheimer's disease progression prediction is difficult because future clinical scores can remain tied to baseline severity, while biomarker histories are irregular and incompletely observed. We develop an anchor-based analysis of 24-month Clinical Dementia Rating Sum of Boxes (CDR-SB) change using harmonized Alzheimer's Disease Neuroimaging Initiative (ADNI) tables. Each labeled sample is anchored at a mild cognitive impairment visit, uses only clinical and biomarker history observed at or before that anchor, and defines the response as CDR-SB at the future visit closest to 24 months within an 18--30 month window minus anchor CDR-SB. The analytic cohort contains 2,600 labeled anchors from 858 participants and 7,276 longitudinal rows. We propose a residual gap-aware transformer that combines a mixed-effects statistical reference with transformer-based residual learning from pre-anchor clinical and biomarker histories. The model uses participant-level random intercepts in the mixed-effects reference, observation-level triplet tokenization for irregular histories, and a learned nonnegative time-gap penalty inside self-attention. We compare the proposed model with a Bayesian-information-criterion-selected linear mixed-effects baseline, GRU-D, and STraTS under repeated participant-level train--test splits. Across five participant-level random seeds, the proposed model achieves the best mean test performance across all reported metrics, reducing MSE by 13.1% and increasing prediction--observation correlation by 26.4% relative to the mixed-effects baseline. It also improves over both GRU-D and STraTS in mean error and correlation. These results show that statistical anchoring and gap-aware residual learning provide a useful structure for medium-horizon Alzheimer's disease progression prediction.

Fast prototyping of new SE(3) estimation objectives remains awkward in practice. Modern Lie-group frameworks -- GTSAM, manif, Sophus, SymForce, Ceres -- target first-order workloads through different code-generation and automatic-differentiation strategies, each optimized for a particular seam between hand-derived geometry and generic differentiation. The remaining gap is a compact, AD-safe path from these first-order primitives to exact Hessians, observed-information matrices, and higher-order derivative tensors: the quantities needed for exact Newton steps, observed-information covariance estimates, and covariance correction. This paper presents a hybrid analytical/AD recipe for SE(3) negative log-likelihoods. The practitioner writes the NLL gradient once, generic over a scalar type, and places the analytical/AD seam at the point-action interface y = Tx. Closed-form Lie-group Jacobians are used up to this interface; AD is applied only beyond it. The same source is then instantiated with ordinary floating-point scalars for gradients, vector-seeded dual numbers for exact Hessians in a single forward-mode pass, and nested dual numbers for higher-order derivative tensors. On a representative 6-DoF, 5-landmark SE(3) NLL, the advocated seeded-Hessian path is approximately 5x faster than finite-differencing the AD gradient on this benchmark while matching a nested-AD oracle to machine precision. The implementation adds roughly 70 lines of analytical-Jacobian code over an AD-only baseline. We also identify and fix a removable singularity in the standard SO(3)/SE(3) scalar basis that would otherwise produce NaNs at the origin under seeded AD, and we audit which Lie-group derivative tensors require this stabilized basis. The result is a practical path from rapidly written SE(3) objectives to exact higher-order derivatives, with predictable runtime and no finite-difference tuning.

Fall detection is a critical task in healthcare, particularly for elderly people. Timely fall detection and treatment can prevent severe injuries. Sensor-based activity data can be used to detect fall. However, this data are highly sensitive and raises significant privacy concerns. Existing privacy approaches apply uniform noise across all training samples, which affects the prediction performance. To address this limitation, we propose a Class-Aware Adaptive Differential Privacy (CA-ADP) framework integrated with a hybrid 3D Convolutional Neural Network and Bidirectional Long Short-Term Memory (3D CNN-BiLSTM) architecture. The CA-ADP mechanism dynamically adjusts the magnitude of noise added to gradients based on the class composition of each mini-batch. This process ensures privacy while mitigates performance degradation. We formally analyze the $(ε,δ)$-Differential Privacy guarantee and provide a privacy-utility trade-off analysis. The proposed method is evaluated on three public benchmark datasets, namely SisFall, UP-Fall, and MobiAct. The experimental results show that the proposed privacy model achieves improvements of 3.3%, 8.5%, and 7.5% over the conventional privacy-based model in terms of F-score for the SisFall, UP-Fall, and MobiAct datasets, respectively. Comparisons with prior studies show that the CA-AD based framework achieves competitive performance and provides formal privacy guarantees, which are largely overlooked in existing studies. Wilcoxon signed-rank tests confirm that the proposed mechanism consistently outperforms conventional differential privacy. Those results establish the proposed CA-ADP framework as an effective approach to privacy-preserving fall detection in real-world healthcare settings.

The systemic, metabolic, lifestyle factors have established associations with Alzheimer's Disease (AD) through epidemiologic and AD-specific biomarker studies. Whether colored fundus photography (CFP) contains retinal structural signatures corresponding to these AD-related risk domains remains unclear. To determine whether deep learning (DL) models can predict 12 AD-related risk factors from CFP and to characterize the retinal structures underlying these predictions, thereby assessing whether CFP reflects pathways to AD vulnerability. Using 62,876 CFPs from 44,501 unique participants from the UK Biobank, DL models were trained to predict 12 factors linked to AD incidence: 6 categorical (sex, smoking, sleeplessness, economic status, alcohol use, depression) and 6 continuous (age, age at completing education, BMI, systolic, diastolic blood pressure, HbA1c). Model performance, model saliency, and saliency-derived scores (CAM-Score) were evaluated and compared to retinal morphometry. The scores were also compared between incident-AD cases (average 8.55 years before onset) and matched controls. Performance of DL ranged from AUROC= 0.5654-0.9480 for categorical and R2=-0.0291-0.7620 for continuous factors, outperforming most of the morphometry-machine learning models. Saliency-based score consistently highlighted biologically meaningful regions, particularly the optic nerve head and retinal vasculature. It also aligned with present morphometric variations. Several saliency-based scores differed significantly between incident AD and matched controls, suggesting potential overlap between retinal correlates of risk factors and preclinical AD-associated changes. CFP encodes retinal signatures linked to AD risk factors. Although not diagnostic, DL-derived retinal representations may uncover biologically meaningful risk-related structural changes mirroring the potential AD vulnerability.

Individualized Alzheimer's disease (AD) progression prediction requires models that use irregular visits, account for censoring, avoid diagnostic leakage, and provide calibrated horizon risks. We propose PROgression-aware MultI-horizon Survival Estimation for Alzheimer's Disease (PROMISE-AD), a leakage-safe survival framework for predicting conversion from cognitively normal (CN) to mild cognitive impairment (MCI) and from MCI to AD dementia using ADNI/TADPOLE tabular histories. PROMISE-AD converts pre-index visits into tokens with standardized measurements, missingness masks, longitudinal changes, time-normalized slopes, visit timing, and non-diagnostic categorical attributes. A temporal Transformer fuses global, attention-pooled, and latest-visit representations to estimate a progression score and latent discrete-time mixture hazards. Training combines survival likelihood, horizon-specific focal risk loss, progression ranking, hazard smoothness, and mixture-balance regularization, followed by validation-set isotonic calibration for 1-, 2-, 3-, and 5-year risks. In held-out testing across three seeds, PROMISE-AD achieved an integrated Brier score (IBS) of 0.085 $\pm$ 0.012, C-index of 0.808 $\pm$ 0.015, and mean time-dependent AUC of 0.840 $\pm$ 0.081 for CN-to-MCI conversion, yielding the lowest IBS among compared methods. For MCI-to-AD conversion, PROMISE-AD achieved the highest C-index (0.894 $\pm$ 0.018) and near-ceiling 5-year discrimination (AUROC 0.997 $\pm$ 0.003; AUPRC 0.999 $\pm$ 0.001), although some baselines had lower IBS. Ablations and interpretability supported longitudinal change features, fused temporal representations, mixture hazards, cognitive and functional measures, APOE4 status, and recent conversion-proximal visits. These findings suggest that progression-aware survival modeling can provide interpretable multi-horizon AD conversion risk estimates.

Cognitive decline is highly heterogeneous across individuals, which complicates prognosis, trial design, and treatment planning. We present the Personalized Cognitive Decline Assessment Digital Twin (PCD-DT), a multimodal and uncertainty-aware framework for modeling patient-specific disease trajectories from sparse, noisy, and irregular longitudinal data. The framework combines three methodological components: (1) latent state-space models for individualized temporal dynamics, (2) multimodal fusion for clinical, biomarker, and imaging features, and (3) uncertainty-aware validation and adaptive updating for robust digital twin operation. We also outline how conditional generative models can support data augmentation and stress testing for underrepresented progression patterns. As a preliminary feasibility study, we analyze longitudinal TADPOLE trajectories and show clear separation between cognitively normal and Alzheimer's disease cohorts in ADAS13, ventricle volume, and hippocampal volume over five years. We further conduct a multimodal next-visit prediction ablation using an LSTM sequence model on 3{,}003 visit-pair sequences derived from TADPOLE, where the combined cognitive plus MRI configuration achieves the lowest standardized RMSE for both ADAS13 (0.4419) and ventricle volume (0.5842), outperforming a Last Observation Carried Forward baseline. A Bayesian tensor modeling component for high-dimensional imaging fusion is also discussed. These results support the feasibility of the proposed architecture while also highlighting the need for stronger uncertainty calibration and longer-horizon predictive evaluation. The PCD-DT framework provides a principled starting point for personalized in silico modeling in neurodegenerative disease. This work positions PCD-DT as a foundational step toward clinically deployable, uncertainty-aware digital twin systems.

Accurate prediction of conversion from Mild Cognitive Impairment (MCI) to Alzheimers Diseases (AD) is essential for early intervention, however, developing reliable conversion predictive models is difficult to develop due to limited longitudinal data availability We evaluate TabPFN (Tabular Pre-Trained Foundation Network) against traditional machine learning methods for predicting 3 year MCI to AD conversion using the TADPOLE dataset derived from ADNI. Using multimodal biomarker features extracted from demographics, APOE4, MRI volumes, CSF markers, and PET imaging, we conducted an experimental comparison across varying training set sizes (N=50 to 1000) and models including XGBoost, Random Forest, LightGBM, and Logistic Regression. TabPFN achieved one the highest performance (AUC=0.892), outperforming LightGBM (AUC=0.860) and demonstrating advantages in low data settings. At N=50 training samples, TabPFN maintained strong AUC while the traditional machine learning models struggles at small training samples. These findings demonstrate that foundation models are promising for disease prediction in data limited scenarios, such as Alzheimers diseases.

Alzheimer's disease is a neurodegenerative disorder marked by progressive declines in memory and language that reduce independence in daily life, motivating socially assistive robotic support. This paper presents MEMOR-E, a mobile quadruped robot with an interactive tablet interface that assists patients and caregivers through medication reminders, routine guidance, memory oriented interactions, and companionship. We evaluated the feasibility of fine tuning large language models (LLMs) to emulate stage consistent cognitive behavior and interpret responses across standard neuropsychological language tasks, using audio transcriptions from 235 Alzheimer's patients and synthetically generated healthy controls. We also report findings on using in context learning (ICL) in LLMs, where a second LLM produced domain and severity level cognitive error summaries. Our results show that MEMOR-E can generate stage aware, non diagnostic cognitive summaries that support personalized assistive interactions, while explainable AI mechanisms translate model outputs into transparent, human readable evidence to enable caregiver oversight and trustworthy human robot interaction.

Patients with dementia typically exhibit cognitive impairment, which is routinely assessed using the Mini-Mental State Examination (MMSE). Concurrently, their underlying neurophysiological abnormalities are reflected in Electroencephalography (EEG), providing a basis for joint modeling. However, traditional multi-task approaches suffer from feature entanglement, which leads to inter-task interference when handling heterogeneous objectives.To address this challenge, we propose a task-guided spatiotemporal network (TGSN) with diffusion augmentation for EEG-based dementia diagnosis and MMSE prediction. Specifically, TGSN integrates a multi-band feature fusion module to capture complementary spectral information from EEG. Meanwhile, a pre-trained data augmentation module utilizing a diffusion process is introduced toincrease sample diversity. To model the complex spatiotemporal patterns of EEG, we propose a gated spatiotemporal attention module that captures long-range spatial dependencies and temporal dynamics. Moreover, we design a task-guided query module to achieve task-specific feature extraction, thereby mitigating task interference. The effectiveness of TGSN is evaluated on the XY02 dataset. Experimental results demonstrate that the proposed network outperforms several state-of-the-art methods, achieving classification accuracies of 97.78% for Alzheimer's Disease (AD)/Frontotemporal Dementia (FTD) and 83.93% for AD/FTD/Vascular Cognitive Impairment (VCI), which exceed the best baselines by 16.39% and 8.28%, respectively. In parallel, it reduces the RMSE for MMSE prediction to 1.93 and 2.38, achieving significant error reductions of 1.44 and 1.43 compared to the best baselines. Additionally, validation on the DS004504 dataset demonstrates strong cross-dataset generalization...

Developing robust and clinically reliable EEG biomarkers requires evaluation frameworks that explicitly address cross population generalization in multi site settings such as Parkinsons disease (PD) detection. Models trained under i.i.d. assumptions often capture population specific artifacts rather than disease relevant neural structure, leading to poor generalization across clinical cohorts. EEG further amplifies this challenge due to low signal to noise ratio and heterogeneous acquisition conditions. We propose a population aware evaluation framework to assess the robustness and clinical reliability of EEG biomarkers under distribution shift. Using an n gram expansion strategy, we enumerate all cross population train test configurations across five independent cohorts, resulting in 75 directional evaluations. A nested cross validation design with integrated channel selection ensures prospective biomarker identification without population leakage. Results show that cross population transfer is asymmetric and that both accuracy and biomarker stability improve with increasing training population diversity, achieving up to 94.1% accuracy on held out cohorts. A theoretical analysis based on mixture risk optimization and hypothesis space contraction explains these trends, showing that multi population training promotes population robust representations. This work establishes a principled framework for learning robust, generalizable, and clinically reliable EEG biomarkers for multi site biomedical applications.

Crop disease diagnosis from field photographs faces two recurring problems: models that score well on benchmarks frequently hallucinate species names, and when predictions are correct, the reasoning behind them is typically inaccessible to the practitioner. This paper describes Agri-CPJ (Caption-Prompt-Judge), a training-free few-shot framework in which a large vision-language model first generates a structured morphological caption, iteratively refined through multi-dimensional quality gating, before any diagnostic question is answered. Two candidate responses are then generated from complementary viewpoints, and an LLM judge selects the stronger one based on domain-specific criteria. Caption refinement is the component with the largest individual impact: ablations confirm that skipping it consistently degrades downstream accuracy across both models tested. On CDDMBench, pairing GPT-5-Nano with GPT-5-mini-generated captions yields \textbf{+22.7} pp in disease classification and \textbf{+19.5} points in QA score over no-caption baselines. Evaluated without modification on AgMMU-MCQs, GPT-5-Nano reached 77.84% and Qwen-VL-Chat reached 64.54%, placing them at or above most open-source models of comparable scale despite the format shift from open-ended to multiple-choice. The structured caption and judge rationale together constitute a readable audit trail: a practitioner who disagrees with a diagnosis can identify the specific caption observation that was incorrect. Code and data are publicly available https://github.com/CPJ-Agricultural/CPJ-Agricultural-Diagnosis

Predicting individual cognitive decline in Alzheimer's disease (AD) is difficult due to the heterogeneity of disease progression. Reliable clinical tools require not only high accuracy but also fairness across demographics and robustness to missing data. We present CognitiveTwin, a digital twin framework that predicts patient-specific cognitive trajectories. The model integrates multi-modal longitudinal data (cognitive scores, magnetic resonance imaging, positron emission tomography, cerebrospinal fluid biomarkers, and genetics). We use a Transformer-based architecture to fuse these modalities and a Deep Markov Model to capture temporal dynamics. We trained and evaluated the framework using data from 1,666 patients in the TADPOLE (Alzheimer's Disease Neuroimaging Initiative) dataset. We assessed the model for prediction error, demographic fairness, and robustness to missing-not-at-random (MNAR) data patterns. ognitiveTwin provides accurate and personalized predictions of cognitive decline. Its demonstrated fairness across patient demographics and resilience to clinical dropout make it a reliable tool for clinical trial enrichment and personalized care planning.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder and a major cause of dementia. Structural MRI is widely used to analyze AD-related brain atrophy; however, most deep learning methods rely on computationally expensive 3D convolutional neural networks (CNNs), limiting deployment in resource-constrained settings. This work introduces two main contributions. First, we propose a pipeline that converts T1-weighted MRI into anatomically informed 2D point clouds using Anatomical Priority Sampling (APS), producing ADNI-2DPC, the first neuroanatomically labeled MRI-derived point cloud dataset. Second, we present NeuroAPS-Net, a lightweight geometric deep learning model that incorporates anatomical priors via region-aware feature encoding and ROI token aggregation. Experiments on ADNI-2DPC demonstrate that NeuroAPS-Net achieves competitive classification accuracy while significantly reducing inference latency and GPU memory compared to state-of-the-art point cloud methods. These results highlight the potential of anatomically guided point cloud learning as an efficient and interpretable alternative to voxel-based CNNs for AD classification.

Timely detection of concerning events is an important problem in clinical practice. In this paper, we consider the problem of conditional anomaly detection that aims to identify data instances with an unusual response, such as the omission of an important lab test. We develop a new non-parametric approach for conditional anomaly detection based on the soft harmonic solution, with which we estimate the confidence of the label to detect anomalous mislabeling. We further regularize the solution to avoid the detection of isolated examples and examples on the boundary of the distribution support. We demonstrate the efficacy of the proposed method in detecting unusual labels on a real-world electronic health record dataset and compare it to several baseline approaches.

In this paper, we consider the problem of conditional anomaly detection that aims to identify data instances with an unusual response or a class label. We develop a new non-parametric approach for conditional anomaly detection based on the soft harmonic solution, with which we estimate the confidence of the label to detect anomalous mislabeling. We further regularize the solution to avoid the detection of isolated examples and examples on the boundary of the distribution support. We demonstrate the efficacy of the proposed method on several synthetic and UCI ML datasets in detecting unusual labels when compared to several baseline approaches. We also evaluate the performance of our method on a real-world electronic health record dataset where we seek to identify unusual patient-management decisions.

Accurate disease classification from radiology reports is essential for many applications. While supervised fine-tuning (SFT) of lightweight LLMs improves accuracy, it can degrade reasoning. We propose a two-stage approach: SFT on disease labels followed by Group Relative Policy Optimization (GRPO) to refine predictions by optimizing accuracy and format without reasoning supervision. Across three radiologist-annotated datasets, SFT outperformed baselines and GRPO further improved classification and enhanced reasoning recall and comprehensiveness.

The retina provides a unique, noninvasive window into Alzheimer's disease (AD) and dementia, capturing early structural changes through morphometric features, while systemic and lifestyle risk factors reflect well-established contributors to disease susceptibility long before clinical symptom onset. However, current retinal analysis frameworks typically model imaging and risk factors separately, limiting their ability to capture joint multimodal patterns critical for early risk prediction. Moreover, existing methods rarely incorporate mechanisms to organize or align patients with similar retinal and clinical characteristics, constraining the learning of coherent cross-modal associations. To address these limitations, we introduce REVEAL (REtinal-risk Vision-Language Early Alzheimer's Learning), a framework that aligns color fundus photographs with individualized disease-specific risk profiles for predicting incident AD and dementia, on average 8 years before diagnosis (range: 1-11 years). Because real-world risk factors are structured questionnaire data, we translate them into clinically interpretable narratives compatible with pretrained vision-language models (VLMs). We further propose a group-aware contrastive learning (GACL) strategy that clusters patients with similar retinal morphometry and risk factors as positive pairs, strengthening multimodal alignment. This unified representation learning framework substantially outperforms state-of-the-art retinal imaging models paired with clinical text encoders, as well as general-purpose VLMs, demonstrating the value of jointly modeling retinal biomarkers and clinical risk factors. By providing a generalizable and noninvasive approach for early AD and dementia risk stratification, REVEAL has the potential to enable earlier intervention and improve preventive care at the population level.

Parkinson's disease (PD) is a chronic neurodegenerative disease. It shows multiple motor symptoms such as tremor, bradykinesia, postural instability, freezing of gait (FoG). PD is currently diagnosed clinically through physical exam by health-care professionals, which can be time consuming and highly subjective. Wearable IMU sensors has become a promising gateway for passive monitoring of PD patients. We propose a self-supervised cross-attention encoder that processes bilateral wrist-worn IMU signals from a public dataset called PADS, consisting of three groups, PD (Parkinson Disease), HC (Healthy Control) and DD (Differential Diagnosis) of a total of 469 subjects. We have achieved a mean accuracy of 93.12% for HC vs. PD classification and 87.04% for PD vs. DD classification. The results emphasize the clinical challenge of distinguishing Parkinson's from other neurodegenerative diseases. Self-supervised representation learning using contrastive infoNCE loss gained an accuracy of 93.56% for HC vs. PD and 92.50% for PD vs. DD using only 20% of labelled data. This demonstrates the effectiveness of our method in transfer learning for clinical use with minimal labels. The real-time applicability was tested by deploying the optimized model with a mean inference time of 48.32 ms per window on a Raspberry Pi CPU.

Alzheimer disease (AD) is a neurodegenerative disease that lacks specific treatment options. Natural drugs have displayed neuroprotective effects; however, their high-throughput discovery is challenging because of the expense of experimental testing.The study proposed a machine learning approach to identify the anti-dementia activity of natural compounds based on molecular descriptors obtained from cheminformatics. The study used a set of active and inactive compounds obtained from public databases like ChEMBL and PubChem. Various molecular descriptors, including molecular weight, lipophilicity (LogP), topological polar surface area (TPSA), and hydrogen bonding descriptors, were calculated with RDKit. Data preprocessing and feature selection were applied, followed by the development of several classification models (Random Forest, XGBoost, Support Vector Machines, Logistic Regression) and their evaluation based on accuracy, precision, recall, F1-score and ROC-AUC. The outcome suggests that ensemble techniques, such as Random Forest, delivered the best predictive accuracy and ROC-AUC values. This study also highlights that critical physicochemical descriptors in particular lipophilicity, molecular weight and polarity are important in driving neuroprotective activity as identified by feature importance analysis. The integrated machine learning approach shows the potential of combining natural product research and machine learning in early drug discovery for dementia. They provide a means of rapidly exploring large datasets and selecting candidates for experimental confirmation, thus minimising costs and time in the development of drugs for neurodegenerative diseases.

Large language models (LLMs) tuned for safety often avoid acknowledging demographic differences, even when such acknowledgment is factually correct (e.g., ancestry-based disease incidence) or contextually justified (e.g., religious hiring preferences). This identity-blindness yields incorrect responses, unnecessary refusals, or generic "equal-treatment" defaults. We study this via difference-awareness classification: given a question involving demographic groups, the task is not to answer directly, but to classify whether a correct answer requires recognizing group differences (yes) or whether groups should be treated identically (no). Crucially, fine-tuning for accuracy triggers harm drift: model-generated explanations become increasingly harmful as decision accuracy improves, whether by elaborating harmful content, introducing problematic assumptions, or failing to flag harms the baseline identified. To mitigate this, we introduce DART (Distill--Audit--Repair Training), which distills label-conditioned reasoning from a teacher, audits outputs for harm drift cases relative to baseline, and repairs problematic cases via severity-weighted fine-tuning. On eight benchmarks, DART improves Llama-3-8B-Instruct accuracy from 39.0% to 68.8%, with largest gains on equal-treatment prompts (11.3% -> 72.6%), while reducing harm drift cases by 72.6%. It also transfers to 280 open-ended real-world queries across medical, legal, policy, and educational domains, improving difference-appropriate responses from 39.8% to 77.5% while reducing refusals from 34.3% to 3.0%. Our results demonstrate that accuracy and safety need not conflict when explicit detection and repair mechanisms are in place.

Alzheimer's disease (AD) confirmation often relies on positron emission tomography (PET) or cerebrospinal fluid (CSF) analysis, which are costly and invasive. Consequently, structural MRI biomarkers such as cortical thickness (CT) are widely used for non-invasive AD screening. Multiscale structural mapping (MSSM) was recently proposed to integrate gray-white matter contrasts (GWCs) with CT from a single T1-weighted MRI (T1w) scan. Building on this framework, we propose MSSM+, together with surface supervertex mapping (SSVM) and a Supervertex Vision Transformer (SV-ViT). 3D T1w images from individuals with AD and cognitively normal (CN) controls were analyzed. MSSM+ extends MSSM by incorporating sulcal depth and cortical curvature at the vertex level. SSVM partitions the cortical surface into supervertices (surface patches) that effectively represent inter- and intra-regional spatial relationships. SV-ViT is a Vision Transformer architecture operating on these supervertices, enabling anatomically informed learning from surface mesh representations. Compared with MSSM, MSSM+ identified more spatially extensive and statistically significant group differences between AD and CN. In AD vs. CN classification, MSSM+ achieved a 3%p higher area under the precision-recall curve than MSSM. Vendor-specific analyses further demonstrated reduced signal variability and consistently improved classification performance across MR manufacturers relative to CT, GWCs, and MSSM. These findings suggest that MSSM+ combined with SV-ViT is a promising MRI-based imaging marker for AD detection prior to CSF/PET confirmation.

Longitudinal neuroimaging is essential for modeling disease progression in Alzheimer's disease (AD), yet irregular sampling and missing visits pose substantial challenges for learning reliable temporal representations. To address this challenge, we propose SDE-HGNN, a stochastic differential equation (SDE)-driven spatio-temporal hypergraph neural network for irregular longitudinal fMRI connectome modeling. The framework first employs an SDE-based reconstruction module to recover continuous latent trajectories from irregular observations. Based on these reconstructed representations, dynamic hypergraphs are constructed to capture higher-order interactions among brain regions over time. To further model temporal evolution, hypergraph convolution parameters evolve through SDE-controlled recurrent dynamics conditioned on inter-visit intervals, enabling disease-stage-adaptive connectivity modeling. We also incorporate a sparsity-based importance learning mechanism to identify salient brain regions and discriminative connectivity patterns. Extensive experiments on the OASIS-3 and ADNI cohorts demonstrate consistent improvements over state-of-the-art graph and hypergraph baselines in AD progression prediction. The source code is available at https://anonymous.4open.science/r/SDE-HGNN-017F.

Accurate extraction of Alzheimer's Disease and Related Dementias (ADRD) phenotypes from electronic health records (EHR) is critical for early-stage detection and disease staging. However, this information is usually embedded in unstructured textual data rather than tabular data, making it difficult to be extracted accurately. We therefore propose LLM-MINE, a Large Language Model-based phenotype mining framework for automatic extraction of ADRD phenotypes from clinical notes. Using two expert-defined phenotype lists, we evaluate the extracted phenotypes by examining their statistical significance across cohorts and their utility for unsupervised disease staging. Chi-square analyses confirm statistically significant phenotype differences across cohorts, with memory impairment being the strongest discriminator. Few-shot prompting with the combined phenotype lists achieves the best clustering performance (ARI=0.290, NMI=0.232), substantially outperforming biomedical NER and dictionary-based baselines. Our results demonstrate that LLM-based phenotype extraction is a promising tool for discovering clinically meaningful ADRD signals from unstructured notes.

Alzheimer's disease is a progressive neurodegenerative disorder in which mild cognitive impairment (MCI) precedes dementia. Structural MRI provides biomarkers but requires costly infrastructure, limiting population-scale deployment. Speech offers a non-invasive alternative, yet speech-only classifiers are developed independently of neuroimaging and lack biological grounding for CN-versus-MCI classification. We propose MINT (Multimodal Imaging-to-Speech Knowledge Transfer), a three-stage framework that transfers MRI-derived biomarker structure to speech during training. An MRI teacher defines a compact embedding space for CN-versus-MCI classification, while a residual projection head aligns speech representations to this space using a combined geometric loss. The frozen MRI classifier enables imaging-free inference. On ADNI-4, aligned speech achieves performance comparable to speech baselines, while multimodal fusion improves over MRI alone. Ablations identify dropout regularization and self-supervised pretraining as important design choices. To our knowledge, MINT is the first demonstration of MRI-to-speech knowledge transfer for early Alzheimer's screening without imaging at inference.

Tau positron emission tomography supports Alzheimer's disease staging but is difficult to scale because of tracer, scanner, and radiation constraints. Synthesis from structural MRI is therefore attractive, but it is a particularly difficult setting. T1-weighted and FLAIR MRI provide anatomy and disease correlated morphology, but they do not directly measure Tau-PET relevant signal. We introduce SFL-Net, a multi-input synthesis framework that predicts Tau-PET from T1-weighted and FLAIR MRI. SFL-Net factorizes the latent representation into shared, T1-specific, FLAIR-specific, and complementary pathways and preserves anatomical detail through latent structural conditioning rather than direct encoder-decoder connections. We evaluated SFL-Net and baseline models using 605 training and 83 validation subjects from ADNI-3 and OASIS-3 datasets. Evaluation included raw image fidelity, standardized uptake value ratio agreement, high uptake overlap, regional Bland-Altman bias, braak derived stage agreement, non-inferiority sensitivity analysis, and latent component Shapley attribution. SFL-Net performed competitively on both clinically relevant and reconstruction metrics, while also delivering explicit source level auditability that conventional UNet derived models lack.

We propose a novel swap-adversarial framework that mitigates high inter-subject variability and the high-dimensional low-sample-size problem in electrocorticography (ECoG) data. It achieves robust domain generalization across ECoG and electroencephalography (EEG)-based brain-computer interface datasets. Our framework integrates (1) robust preprocessing, (2) inter-subject balanced channel swap (ISBCS) for cross-subject augmentation, and (3) domain-adversarial learning (DAL) to suppress subject-specific bias. The ISBCS method is a bio-inspired channel swapping strategy that exchanges only functionally corresponding channels across subjects, guided by a brain map, to mitigate inter-subject distribution differences. The DAL strategy encourages the model to learn task-relevant shared features. We validate the effectiveness of this framework through extensive experiments under cross-subject, cross-session, and cross-dataset settings. Our framework consistently outperforms all baselines across all settings, showing the most significant improvements in highly variable environments. It also achieves superior cross-dataset performance between public EEG benchmarks, demonstrating strong generalization capability not only for ECoG but also for EEG data. In addition, we introduce a new ECoG dataset, the first reproducible benchmark, which is constructed from long-term ECoG recordings of 6-hydroxydopamine-induced rat models and annotated with neural responses measured before and after electrical stimulation.

Generative modeling frameworks have emerged as an effective approach to capture high-dimensional image distributions from large datasets without requiring domain-specific knowledge, a capability essential for disease progression modeling. Recent generative approaches have attempted to capture progression by mapping images to a latent space and guiding representations to generate follow-up images from previous time points. However, these methods impose constraints on distribution learning, resulting in latent spaces with limited controllability for generating follow-up images without paired subject-specific longitudinal guidance. In order to enable controlled movements in the latent representational space and generate progression images from a previous time-point image without subject-specific guidance, we introduce a conditionable Diffusion Auto-encoder framework that forms a compact latent space capturing high-level semantics and providing means to control generation. Our approach leverages this latent space to condition and apply controlled shifts to the representations of previous time-point images by isolating progression and subject identity information for generating follow-up images. The shifts are implicitly guided by correlating with progression attributes and constraining to Alzheimer's disease specific regions, without paired longitudinal guidance. We validate the generations through image quality metrics, volumetric progression analysis, and downstream tasks in Alzheimer's disease datasets from different sources. This demonstrates the effectiveness of our approach for Alzheimer's progression modeling and longitudinal image generation.

Dementia disorders such as Alzheimer's disease (AD) and frontotemporal dementia (FTD) exhibit overlapping electrophysiological signatures in EEG that challenge accurate diagnosis. Existing EEG-based methods are limited by full-band frequency analysis, which hinders the precise differentiation of dementia subtypes and severity stages. To address this limitation, we propose a Variational Mixture of Graph Neural Experts (VMoGE) framework that integrates multi-band EEG analysis with variational graph neural networks and a mixture-of-experts architecture. Each expert specializes in a specific EEG frequency band and models brain connectivity using a Gaussian Markov random field prior, while a variational gating mechanism adaptively integrates the expert outputs. This design enables the model to learn frequency-specific brain network representations while modeling latent uncertainty through variational inference. Experimental results on two EEG dementia datasets show that VMoGE achieves strong performance, with an AUC of 0.89 for HC vs. AD classification in the main comparison and competitive results across dementia subtyping and CDR staging tasks. Clinically, VMoGE offers three key translational values: the expert gating weights correlate with MMSE scores and CDR severity; slow-wave $δ$- and $θ$-band contributions are associated with AD-related EEG slowing and disease progression; and spatially localized activation maps reveal posterior $θ$- and $α$-band alterations and region-specific $β$-band changes, providing neurophysiologically interpretable markers aligned with known AD neuropathology.

Early detection of PD remains particularly challenging in resource-constrained settings, where voice-based analysis has emerged as a promising non-invasive and cost-effective alternative. However, existing studies predominantly focus on English or other major languages; notably, no voice dataset for PD exists for Bengali -- a language spoken by over 230 million people worldwide -- posing a significant barrier to culturally inclusive and accessible healthcare solutions. We present BenSparX, the first Bengali conversational speech dataset for PD detection, along with a robust and explainable ML framework tailored for early diagnosis. The proposed framework incorporates diverse acoustic feature categories, systematic feature selection methods, and state-of-the-art ML classifiers with extensive hyperparameter optimization. Furthermore, to enhance interpretability and trust in model predictions, the framework incorporates SHAP (SHapley Additive exPlanations) analysis to quantify the contribution of individual acoustic features toward PD detection. Our framework achieves state-of-the-art performance, yielding an accuracy of 95.67%, F1 score of 95.62%, and AUC of 0.990. We further validated our approach by applying the framework to existing PD datasets in other languages, where it consistently outperforms state-of-the-art approaches. This study lays the foundation for identifying subtle yet clinically meaningful vocal biomarkers, particularly in low-resource settings such as Bengali-speaking populations, and represents a significant step toward equitable, explainable, and robust digital health diagnostics for neurodegenerative disorders. The labelled acoustic-feature dataset derived from the audio recordings in this study is available at https://github.com/riadEDU/BenSParX.

Dementia affects over 55 million people worldwide, projected to reach 139 million by 2050, with Alzheimer's disease (AD) accounting for 60-70% of cases. AD is associated with disruptions in metabolic brain connectivity. Detecting these disruptions early is crucial for AD management. FDG-PET is a useful tool for identifying such impairments. However, most studies rely on group-level analyses or thresholding, potentially masking individual differences and overlooking weaker yet biologically critical brain connections. Moreover, AD prediction largely focuses on univariate rather than multivariate outcomes. To address this, we introduce explainable graph-theoretical machine learning (XGML), a framework for constructing individual metabolic brain graphs and identifying subgraphs most predictive of multivariate disease-related outcomes. Using Alzheimer's Disease Neuroimaging Initiative (ADNI) FDG-PET data, we compared six graph representations against three non-graph baselines, each with six machine learning models using repeated stratified 3-fold cross-validation (10 repeats). The best configuration combined kernel density estimation with Hellinger distance and random forest. Across eight cognitive scores, it reached an overall Fisher-z-averaged Pearson correlation of r=0.595, with strongest performance for ADAS13 (r=0.67), ADAS11 (r=0.65), and ADASQ4 (r=0.62). We identified key edges that were jointly but differentially predictive across outcomes, suggesting their potential as network biomarkers of cognitive decline. Preliminary external feasibility validation on an OASIS3 cohort yielded weak predictive performance for CDRSB (r=0.26) and MMSE (r=0.18), likely reflecting cohort, protocol, and diagnostic differences. Overall, our results suggest the promise of graph-theoretical machine learning for biomarker discovery, disease prediction, and understanding the neural mechanisms underlying AD.

Radiology report generation (RRG) has attracted significant attention due to its potential to reduce the workload of radiologists. The performance of current RRG approaches remains unsatisfactory against clinical standards. This paper introduces a novel RRG method, MLLM-RRG, that integrates multimodal large language models (MLLMs) with various types of clinical knowledge to generate accurate and comprehensive chest X-ray reports. Our method first designs a referring anatomical feature extractor that leverages anatomical knowledge to analyze different regions of the chest X-ray image and extract visual features without explicitly detecting regions. Next, based on the MLLM's decoder, we develop a multimodal report generator that leverages multimodal prompts constructed from dedicated visual features and textual instructions to produce the radiology report in an auto-regressive way. Finally, we introduce a disease-oriented clinical classification and alignment scheme in a multi-task learning manner to leverage disease knowledge to better preserve the clinical relevance among the generated reports. Once the model is trained, we also introduce a novel clinical quality reinforcement learning strategy to enhance the MLLM with report knowledge, further refining the tones of the generated reports towards radiologists. Extensive experiments on the MIMIC-CXR and IU X-Ray datasets demonstrate the superiority of our method over the state of the art. Our codes will be available at https://github.com/viscom-tongji/MLLM-RRG.

Conversational speech reveals early signs of cognitive decline, including dementia and mild cognitive impairment (MCI). AI models show promise for speech-based screening, yet most research focuses on monolingual groups. In the UK, dementia is projected to rise fastest among Black and Asian communities, where multilingualism is common, making equity assessment critical. We recruited 1,395 participants (monolingual English speakers and multilingual speakers from Sheffield/Bradford) and collected over 263 hours of speech via the CognoMemory agent. Multilingual participants spoke English alongside Somali, Chinese, or South Asian languages (Hindi, Urdu, Punjabi, Mirpuri, Arabic). We evaluated ASR (Whisper, Wav2Vec 2.0, NeMo) and downstream AI models for cognitive classification and MMSE regression. ASR accuracy showed no significant differences across groups. However, downstream models exhibited systematic disparities: multilingual speakers were more often misclassified as impaired, especially in memory, fluency, and reading tasks. False-positive rates were substantially higher for multilingual (28 to 37%) than monolingual (12 to 16%) speakers, meaning multilingual individuals were approximately 2.5 times more likely to receive incorrect impairment labels. These biases worsened when models were trained on DementiaBank. This is the first large-scale analysis of false-positive bias in speech-based AI cognitive screening for UK multilingual ethnic minorities. Despite strong overall performance, current models show measurable disparities affecting multilingual speakers. Addressing these biases is essential for safe, equitable deployment in diverse healthcare settings.