High-Order MRI Attention for Differential Dementia Diagnosis

Original Title: Biomarkers

Journal: Alzheimer's & dementia : the journal of the Alzheimer's Association

DOI: 10.1002/alz70856_106312

Overview

Accurate differential diagnosis of dementia types is essential for appropriate treatment. This study utilizes T1-weighted magnetic resonance imaging data and a deep learning approach to distinguish between Alzheimer’s disease and other forms of cognitive impairment. The researchers focus on four specific conditions: Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies, and subcortical vascular dementia. The methodology involves training a model on a large dataset of over 12,091 patients to identify patterns associated with amyloid and tau pathology. By analyzing how different dementia subtypes deviate from the typical Alzheimer’s pattern, the system generates specific risk scores for each condition.

Novelty

The primary contribution of this work is the implementation of a high-order attention mechanism to extract features from brain imaging. Unlike traditional methods that rely solely on cortical atrophy or simple volume measurements, this approach learns low-order attention based on amyloid and tau positivity within the Alzheimer’s disease spectrum. The high-order attention then evaluates the importance of each anatomical feature and the relationships between them. This allows for the creation of non-Alzheimer-specific risk scores derived from weighted feature importances. Specifically, the study identified five distinct features for Parkinson’s disease, six for dementia with Lewy bodies, and eight for subcortical vascular dementia, such as white matter hypointensities and the choroid plexus.

Potential Clinical / Research Applications

This technology can be integrated into clinical decision support systems to help neurologists differentiate between dementia types more accurately during early stages. In research settings, the high-order attention scores could serve as objective biomarkers for patient stratification in clinical trials, ensuring that participants are grouped by their specific underlying pathology. Furthermore, the identification of specific regions like the ventral diencephalon for dementia with Lewy bodies or the choroid plexus for vascular dementia provides targets for further longitudinal studies. Because the model outperforms raw region-of-interest volumes, it offers a more precise tool for monitoring disease progression and evaluating the efficacy of subtype-specific therapies in diverse patient populations.