AI tool improves diagnostic accuracy for dementia by 26%

Boston University researchers have developed an artificial intelligence tool designed to assist physicians in diagnosing the specific causes of cognitive decline. The findings were reported in Nature Medicine. While Alzheimer’s disease is the most recognized cause of dementia, it’s not the only one. The diagnostic challenge is compounded by the fact that multiple causes of dementia can occur simultaneously, making it difficult for physicians to arrive at a definitive diagnosis quickly. This delay often hampers timely intervention.

The researchers, led by Vijaya B. Kolachalama, PhD, an expert in using computational tools to aid in medical diagnoses, created an AI-driven platform capable of identifying up to 10 types of dementia, including vascular and frontotemporal dementia. This advanced tool integrates commonly collected patient data—such as medical history, medication use, demographic information, and scores from neurological and neuropsychological exams—with neuroimaging data like MRI scans. The AI then generates a prediction of the type of dementia a patient has, along with a confidence score, offering valuable insights to guide clinical decisions.

“Our goal is for AI to assist in identifying these disorders early, thereby enabling physicians to manage their patients more effectively and potentially prevent the diseases from worsening,” says Kolachalama, who serves as an associate professor of medicine and computer science at BU, in a statement.

The platform’s development represents a collaboration between BU researchers and external experts. Trained on data from over 50,000 individuals across nine global datasets, the AI tool has been rigorously tested, according to the researchers. In a study comparing neurologists working alone to those assisted by the AI, the tool improved diagnostic accuracy by 26%.

This AI tool is particularly valuable because it can function with limited data, which is crucial for health care providers in resource-constrained settings. Kolachalama said that in low-income regions, where MRI machines are less accessible, having a tool that can operate effectively with available clinical data is essential for expanding the reach of this technology.

Kolachalama also notes the increasing strain on health care systems due to a global shortage of neurology experts and a growing number of patients with neurological conditions. By enhancing diagnostic accuracy and efficiency, this AI tool has the potential to significantly alleviate the burden on physicians with limited time and resources.

Looking ahead, Kolachalama said he and his team are focused on bringing this AI platform into hospitals and clinics for real-world testing. The hope is that this technology will soon become an integral part of the diagnostic process, helping to improve outcomes for patients with dementia worldwide.

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Where a patient lives may be the biggest factor for a dementia diagnosis

A University of Michigan study found significant regional differences in the likelihood of receiving a dementia diagnosis in the United States, which could have profound implications for accessing new treatments for Alzheimer's disease and other forms of dementia. The research found that the percentage of people diagnosed with dementia each year varies widely across regions, with particularly stark differences for those aged 66 to 74 and individuals who are Black or Hispanic.

The study, published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, suggests that where a person lives may play a more significant role in whether they receive a dementia diagnosis than individual risk factors. According to the findings, someone in one region of the U.S. could be twice as likely to be diagnosed with dementia as someone in another region.

Julie Bynum, M.D., a U-M Health geriatrician and lead author of the study, emphasized the need to address these disparities. "These findings go beyond demographic and population-level differences in risk and indicate that there are health system-level differences that could be targeted and remediated," said Bynum in a statement. She noted that the variation in diagnosis rates could be due to differences in health care practices, patient knowledge, and care-seeking behaviors.

The study analyzed data from 4.8 million Medicare beneficiaries aged 66 and older in 2019, focusing on "diagnostic intensity" across 306 hospital referral regions (HRRs). Researchers found that while nearly 7 million Americans currently have a dementia diagnosis, many more likely have symptoms but remain undiagnosed. Access to advanced dementia treatments, including new medications and diagnostic tests, requires a formal diagnosis.

The study found that the prevalence of diagnosed dementia ranged from 4% to 14% across HRRs, with new diagnoses in 2019 ranging from 1.7% to 5.4%. After adjusting for various factors, including education level, smoking rates, obesity, and diabetes, researchers calculated that people in low-intensity areas were 28% less likely to be diagnosed with dementia, while those in high-intensity areas were 36% more likely.

The concentration of dementia diagnoses was highest in the southern U.S., but this pattern shifted once researchers accounted for other risk factors. Bynum suggested that the variation could stem from differences in clinical practices, such as how frequently primary care physicians screen for dementia or the availability of specialists.

Bynum called for increased efforts to ensure early identification of cognitive issues, especially in younger Medicare populations. She also encouraged individuals to advocate for themselves to receive cognitive screenings, which are covered by Medicare during annual wellness visits.

Bynum highlighted Medicare's recent GUIDE model for dementia care as a potential avenue for improving care coordination and access. This new model incentivizes clinical practices to provide better dementia care and offer 24/7 access to trained providers.

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Researchers Find New Method to Measure Cognitive Impairment, Dementia

This article, " Health-Deficit Accumulation Affects Risk for Mild Cognitive Impairment, Dementia," was originally published in NeurologyLive.

Using a frailty index score could enable clinicians to identify patients at risk for cognitive dysfunction, making it an important marker for prognostic value.

Newly published data suggests health-deficit accumulation, specifically among older Americans, affects the likelihood of progressive cognitive impairment, as well as the likelihood of cognitive improvement independent of the APOE ε4 allele.

Lead author David D. Ward, PhD, postdoctoral fellow, geriatric medicine research, Centre for Health Care of the Elderly, Nova Scotia Healthy Authority, and colleagues calculated a frailty index score using the deficit-accumulation approach in participants aged 50 years and older from the National Alzheimer’s Coordinating Center (NACC).

Among those not cognitively impaired (NCI; n = 9773), each 0.1 increment increase in score were associated with a higher risk of developing mild cognitive impairment (MCI) and a higher risk of developing dementia.

In total, there were 14,490 participants in the study with a mean age of 72.2 years. In the MCI subsample (n = 4717) at baseline, there was a higher degree of frailty that was associated with a lower probability of being reclassified as NCI from MCI, a higher risk of returning to MCI in those who were reclassified as NCI, and a higher risk of progressing to dementia.

"We conclude that frailty is a key risk factor for age-related cognitive dysfunction and dementia, representing both a target for interventions aimed at the prevention of age-related cognitive impairment and possible prognostic marker among those who have MCI,” the authors wrote.

The score is a health-state measure, incorporating information from multiple physiological systems, and closely reflects an individual’s risk for adverse health events and mortality independently of chronological age. A higher frailty index score indicated accumulation of more age-related health deficits while approximating biological age.

The researchers aimed to detail the dynamic nature of cognitive functioning by calculating the likelihood of transitions between cognitive states in both directions over a 12-month period. Decline of cognitive function was considered forward transition, whereas improvement of cognitive functioning was defined as backwards transition.

The investigators also assessed whether frailty index score and APOE ε4 allele carrier status exerted independent or interactive effects on cognitive-state transition probabilities.

They found no statistically significant interactions between these variables for any transition in the NCI subsample. However, in the MCI subsample, the association of the frailty index score and the risk of progressing to dementia was significantly weaker in those carrying an APOE ε4 allele than in non-carriers (interaction hazard risk [HR], 0.88; 95% CI, 0.80–0.97).

There were no meaningful differences in these associations when participants whose race was other than white were removed from the analytical sample. Notably, associations of the frailty index score with transition probabilities did not differ significantly between men and women.

Over 12 months, NCI subsample participants maintained their prior state 43,086 times (90.6%) and transitioned between states 4491 times (9.4%), 3086 (68.7%) of which were transitions between cognitive states, with 1405 (31.3%) transitions to death. Of the cognitive-state transitions in the NCI subsample, 80.9% were forward transitions, and 19.1% were backward transitions. In the MCI subsample, 70.5% were forward compared to 29.5% who experienced backwards transition.

"This work supports an emerging conceptualization of late-onset dementia as a complex outcome of aging that often is intimately related to an individual’s general health, as well as genetic risk factors,” the authors wrote.

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Particulate Matter Increases Future Risk of Alzheimer Disease

Progressive brain atrophy known to be predictive of Alzheimer disease (AD) is linked to late-life exposure to particulate matter with aerodynamic diameters <2.5-μm (PM2.5), according to new research.

Longitudinal analyses showed that for each interquartile range (IQR) increase (IQR, 2.82- μg/m3) of PM2.5, the associated risk of developing AD increased by 24% (hazard ratio [HR], 1.24; 95% CI, 1.14–1.34) over a 5-year period, as assessed by increased AD pattern similarity (AD-PS) scores. This association remained within levels of PM2.5 below US regulatory standards (<12-μg/m3).

Principal author Diana Younan, PhD, research associate, University of Southern California, stated in a related release that the “findings have important public health implications because not only did we find brain shrinkage in women exposed to the highest levels of PM2.5 pollution but we also found it in women exposed to levels lower than those that the EPA considers safe.”

Younan and colleagues investigated data from 1365 women free of dementia with a mean age of 77.9 years (standard deviation [SD], 2.7) that participated in the WHIMS Magnetic Resonance Imaging (WHIMS MRI) study.

MRI data at baseline and after 5 years was investigated. AD-PS scores—which have been shown to be associated with known risk factors of AD and poor cognitive function—were developed by a supervised machine learning algorithm by comparison of MRI data from the AD Neuroimaging Initiative of gray matter atrophy in areas vulnerable to AD such as the amygdala, hippocampus, thalamus, midbrain, parahippocampal gyrus, and inferior temporal lobe areas.

In longitudinal analysis, IQR-increments were significantly associated with a 0.031 (β = 0.031; 95% CI, 0.017–0.046) increase in AD-PS score.

In fully adjusted models the association was 0.026 (95% CI, 0.009–0.043), which correlates to the 24% increase of AD risk. This association remained after adjusting for socio-demographics, lifestyle, and clinical characteristics including cerebrovascular factors such as white matter lesion volume and stroke, challenging previous studies that have proposed a cerebrovascular mechanism of PM2.5 damage leading to brain atrophy.

Instead, Younan and colleagues favor the theorized mechanism that PM2.5 directly contributes to the neurodegenerative process of dementia via a neurotoxic effect on brain structure.

Sensitivity analyses confirmed the positive association between PM2.5 and AD-PS score after adjusting for baseline AD-PS scores. No association was seen between PM2.5 and baseline AD-PS score in cross sectional analyses (β = –0.004; 95% CI, –0.019 to 0.011).

Previous analyses of WHIMS MRI include region-of-interest analyses that showed residence in areas with higher PM2.5 was associated with smaller total brain and white matter volumes, and that residing in places with >12-μg/m3 concentrations of PM2.5 increased the risk of global cognitive decline by 81% and all-cause dementia by 92%.

Younan and colleagues call for future studies “to fully investigate whether the neurodegenerative effects of late-life exposures to airborne particles may be contributed by or independent of cerebrovascular damage before or during late life...to replicate these results and to thoroughly explore other measures of cerebrovascular damage that may not be captured by white matter lesions and were not explored in our study (e.g., microbleeds; lacunar infarcts).”

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Sandra Day O’Connor’s farewell letter is a plea for country before party

By Ephrat Livni22 minutes ago


Sandra Day O’Connor is not an average American, and there’s plenty of evidence to support this contention.


For one, she was the first woman to serve on the US Supreme Court, appointed in 1981 by Ronald Reagan. And she’s remained active in public life even after her retirement in 2006, committed to advancing civic learning and sharing her passion for the US Constitution and the government it lays out. Today (Oct. 23), she announced she’s stepping out of the limelight because she’s been diagnosed with the beginning stages of dementia and probably has Alzheimer’s disease.


In a sort of farewell letter to the nation (pdf), she urges the rest of us to take up the cause of active citizenship that she can no longer devote herself to entirely, writing:


I feel so strongly about the topic because I’ve seen first-hand how vital it is for all citizens to understand our Constitution and unique system of government, and participate actively in their communities. It is through this shared understanding of who we are that we can follow the approaches that have served us best over time–working collaboratively together in communities and in government to solve problems, putting country and the common good above party and self-interest, and holding our key governmental institutions accountable.


O’Connor, 88, is a pioneer in more ways than one. In 2010, she started iCivics, a non-profit institution that provides free civics games and tutorials to students online and creates lesson plans for teachers in classrooms. On the site, she explains the project, saying, “The practice of democracy is not passed down through our gene pool. It must be taught and learned anew by each generation of citizens.”


In her letter today O’Connor called on all Americans to commit to the project of democracy by engaging in their communities and participating. “It’s not enough to understand, you’ve got to do something,” she writes.


If anyone is in a position to say this, it’s O’Connor, who as a self-described “young cowgirl from the Arizona desert” never could have imagined becoming the first woman on the high court. “I hope that I have inspired young people about civic engagement and helped pave the pathway for women who may have faced obstacles pursuing their careers,” she writes. “While the final chapter of my life with dementia may be trying, nothing has diminished my gratitude and deep appreciation for the countless blessings in my life.”


In response to O’Connor’s announcement, chief justice John Roberts issued a brief statement (pdf), writing that he is saddened by the news but “not at all surprised” that she used the moment “to think of our country first, and to urge an increased commitment to civics education, a cause to which she devoted so much of her time and indomitable energy.” He called her “a towering figure in the history of the United States and indeed the world” and “a role model not only for girls and women, but for all those committed to equal justice under law.”


Roberts concluded, that “no illness or condition can take away the inspiration she provides for those who will follow the many paths she has blazed.” It’s a sentiment that everyone can agree with—whatever their political affiliation.

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When is it Time to Place a Loved One with Dementia?

 One of the most frequent questions we get on Memory People is, "How do I know when it's time to place my loved one?" This, of course, is different for every patient, but it is also different for every caregiver. My rule of thumb is, and always has been, that there is no downside to placing a loved one in a facility too soon.

There are many drawbacks to waiting too long, and none of them are good. The number of things that can potentially go wrong in waiting too long to place a loved one are endless. Here are a few examples:

Medications In a facility, the medications are regulated and can be changed, usually within the hour for whatever reason. When your loved one is living at home, try getting them to the doctor for an evaluation to change their meds. This in itself can be a disaster, and is unnecessary once you have placed them.

Mobility Toward the end stages of dementia and Alzheimer's, patients have extremely limited mobility. Take a 70 year old spouse, weighing in at about 90 lbs. soaking wet, trying to get her 180-pound husband to the bathroom two or three times each night. All this does is put both of them in danger of falling. The end result could be a broken hip which, in some elderly people, is in itself a death sentence. Bathing, toileting, dressing, and other activities of daily living all come with risks, but a facility is better equipped to safely handle all of these. Then there's the fear of them getting out of the house without you knowing. Wandering can (and does) happen in a facility, but the chances of your loved one wandering there are a lot slimmer. The response time when someone does wander is greatly increased as well, due to the number of employees available to look for them.

Stress Anyone who cares for a loved one knows what I am talking about here. It doesn't matter if you are in your thirties or in your seventies, the stress that dementia puts on a caregiver is the same. If you are in your thirties, chances are you’re in reasonably good health. If you are in your seventies, you are more likely to have several medical conditions of your own to contend with. Stress can quickly manifest itself in people of any age, and is known to exacerbate even minor ailments. Sometimes placement in a facility is best for both the caregiver and the loved one’s overall health and wellbeing.


Long-distance caregiving This rarely works. How could it? Some dementia patients have the help of local family members, but they still struggle to stay on top of the care and assistance that their loved ones require. Some try to do this from hundreds or thousands of miles away, but adequate supervision and care can't be provided from afar. If you are a caregiver who is doing this, you know what I am talking about.

Have a plan The most important reason to have a plan way before it comes time to even think about placement is because you said you would. What does that mean, "You said you would"? It means that somewhere along the line you probably promised to take care of your parents, your spouse, your siblings, whomever. You may have said that you would never place them in a nursing home for any reason. Well, never sometimes arrives before we know it. I am telling you this as a patient who knows his destiny. I know what is coming. In a year or two, I may not understand. But right now I do, and I do not want to put my wife or our daughter through that. Period. Then there’s the fact that, as a patient, I deserve and demand to be taken care of to the best of one’s ability. My daily care should not be substandard simply because of a promise you made some 20 or 30 years ago. Chances are, we all have made promises we haven't kept for one reason or another. This thing about, "I promised my Mom I would never put her in a facility," is noble, but that’s about it. Dignity also plays a huge role in this. We all want to be cared for with dignity. A patient may not be able to communicate or have any idea what is going on around them, but they deserve to have their dignity remain intact. It tends to be a matter of pride for their caregivers as well, believe it or not. One doesn't want their family to know they can no longer take care of their Dad, so they do the best they can, not even realizing that the care they are trying to provide is substandard at best. Every patient deserves to be taken care of. That should never even be up for debate, but it often is. In closing, I want to tell you something, and you need to think about this. Placing your loved one in a facility needn't be the dramatizing thing it is portrayed to be. The nursing homes these days are nothing like they were 30 years ago when you made that promise to never place them. Chances are neither the patient nor the caregiver have ever been in a facility that cares for dementia patients. Why is that? Because no one has a plan. Some think that one day they will decide they can no longer handle being a caregiver, just drive up to a facility with their loved one in the back seat, and tell the nurse at the desk you have arrived and you can't do this anymore. This only happens in movies. The only person who can place your loved one is their doctor. You, as their caregiver, can and should acknowledge when you can no longer handle these responsibilities, but it is only by doctor’s orders that a patient can be placed in facility. It is imperative to have some sort of long-term care insurance in place, which has to be purchased before your loved one was even diagnosed way back when. But this rarely happens. So you have to depend on what money your parents have, and it’s likely you have no idea where or how much that is. Another issue is whether the facility you are looking at has room for your loved one. Again, you can't just drive up and expect the facility of your choice to have a vacant room waiting for you. This post could be twice as long, and I still would have just grazed the surface on why you need to have a plan when it comes to placement. Do yourself and your loved one a favor and be prepared. To me, placing a loved one is one of the most loving things you will ever do for them. You are doing something your heart tells you not to, but you are doing something that your mind knows is the right thing to do. This is exactly what you said you would do all those years ago: take care of them. When you can no longer manage, you seek out placement. This is, in fact, taking care of them.

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Caring for a Loved One with Dementia: It Takes a Village

In my last report on Charlie’s journey with his latest health crisis, he had moved to his daughter’s home five hours from me. It seemed to be going well, but then things suddenly took a turn. His daughter found that full-time caregiving in a home setting on top of responsibilities for children, a husband and a home to manage was more than she could handle. At her wits end, they arrived on my doorstep in the middle of the night three weeks ago.

Charlie was ecstatic to be home, while I welcomed him with trepidation. At the end of his hospital stay, I was prepared to place him in nursing home. To have him suddenly returned home, with all VA help discontinued, was upsetting to say the least. The first thing I did was reapply to the VA to have the Home Based Care Plan and Veterans In Place program re-established. This involved a lot of paperwork, and I am still waiting for the services to begin. In the mean time, we are muddling through, but doing surprisingly well. His condition has improved considerably since he was discharged from the hospital. In fact, physically, he is almost back to where he was before a bacterial infection and rheumatoid arthritis laid him flat. However, his mental acuity has suffered. A VA provider gave him a mental test this week in which he scored one-half what he scored six months ago. Today he cleaned his glasses with Whiteout, the product meant to cover errors on paper. In case you were wondering, no—it is not water-soluble. I laughed hysterically as I scraped it off his glasses with my fingernail.


His incontinence has also worsened since his hospitalization. The doctors are not sure what to blame for that; it may just be a result of his worsening dementia. So far, he is able to use a urinal at night, so I can sleep through the night without getting up 5-6 times to help him to the bathroom. The downside was the night he spilled his urinal on the newly cleaned carpet. There was a throw rug in place to catch such spills, but, as luck would have it, it overshot the rug. I’m afraid I lost my cool over that one. Charlie’s love affair with wine seems to be history, though. After six weeks of hospital sobriety, I decided to try playing the fool’s game. Whenever he asks for a glass of wine, I pour him a “cocktail” of red or white sparkling grape juice, fruit flavored water and ginger ale. He has never questioned what kind of “wine” he was drinking or noticed that he did not get the expected rush from the drink. After nine weeks of “freedom” while Charlie was in the hospital and with his daughter, I have found the confinement resulting from caring for someone with mental and physical ailments to be stifling and exhausting. Once I have some helpers in place, the job will not be so daunting. I can’t imagine what many of my readers are going through with little or no help available to give them a break from the stress and loneliness of caregiving. It only took Charlie’s daughter three weeks to realize she couldn’t do it, but she had a solution to her dilemma that many of you do not have access to. God bless you all.

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