Using artificial neural networks in clinical neuropsychology: High performance in mild cognitive impairment and Alzheimer's disease

Abstract

Mild cognitive impairment (MCI) is a transitional state between normal aging and Alzheimer disease (AD). Artificial neural networks (ANNs) are computational tools that can provide valuable support to clinical decision making, classification, and prediction of cognitive functioning. The aims of this study were to develop, train, and explore and develop the ability of ANNs to differentiate MCI and AD, and to study the relevant variables in MCI and AD diagnosis. The sample consisted of 346 controls and 79 MCI and 97 AD patients. A linear discriminant analysis (LDA) and ANNs with 12 input neurons (10 subtests of a neuropsychological test, the abbreviated Barcelona Test; age; and education), 4 hidden neurons, and output neuron (diagnosis) were used to classify the patients. The ANNs were superior to LDA in its ability to classify correctly patients (100–98.33% vs. 96.4–80%, respectively) and showed better predictive performance. Semantic fluency, working and episodic memory and education showed up as the most significant and sensitive variables for classification. Our results indicate that ANNs have an excellent capacity to discriminate MCI and AD patients from healthy controls. These findings provide evidence that ANNs can be a useful tool for the analysis of neuropsychological profiles related to clinical syndromes.

Keywords:

• Artificial neural networks
• Mild cognitive impairment
• Alzheimer disease
• Assessment classification

Acknowledgments

Members of the Neuronorma Study Team: Steering committee: J. P.-C., Hospital del Mar, Barcelona, Spain; R. B., Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; M. A., Hospital Mútua de Terrassa, Terrassa, Spain. Principal investigators: J. P.-C., Hospital del Mar, Barcelona, Spain; R. B., Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; M. A., Hospital Mútua de Terrassa, Terrassa, Spain; J. L. M., Hospital Clínic, Barcelona, Spain; A. R., Hospital Clínico Universitario, Santiago de Compostela, Spain; M.S.B. (deceased), Hospital Clínico San Carlos, Madrid, Spain; C. A., Hospital Virgen Arrixaca, Murcia, Spain; C. M.-P., Hospital Virgen Macarena, Sevilla, Spain; A. F.-G., Hospital Universitario La Paz, Madrid, Spain; M. F., Hospital de Cruces, Bilbao, Spain. Genetics substudy: Rafael Oliva, Service of Genetics, Hospital Clínic, Barcelona, Spain. Neuroimaging substudy: Beatriz Gómez-Ansón, Radiology Department and IDIBAPS, Hospital Clínic, Barcelona, Spain. Research Fellows: Gemma Monte, Elena Alayrach, Aitor Sainz, and Claudia Caprile, Fundació Clinic, Hospital Clinic, Barcelona, Spain; Gonzalo Sánchez, Behavioral Neurology Group, Institut Municipal d'Investigació Médica, Barcelona, Spain. Clinicians, psychologists, and neuropsychologists: Nina Gramunt (Coordinator), Peter Böhm, Sonia González, Yolanda Buriel, María Quintana, Sonia Quiñones, Gonzalo Sánchez, Rosa M. Manero, Gracia Cucurella, Institut Municipal d'Investigació Mèdica, Barcelona, Spain; Eva Ruiz, Mónica Serradell, Laura Torner, Hospital Clínic, Barcelona, Spain; Dolors Badenes, Laura Casas, Noemí Cerulla, Silvia Ramos, Loli Cabello, Hospital Mútua de Terrassa, Terrassa, Spain; Dolores Rodríguez, Clinical Psychology and Psychobiology Dept. University of Santiago de Compostela, Spain; María Payno, Clara Villanueva, Hospital Clínico San Carlos, Madrid, Spain; Rafael Carles, Judit Jiménez, Martirio Antequera, Hospital Virgen Arrixaca, Murcia, Spain; Jose Manuel Gata, Pablo Duque, Laura Jiménez, Hospital Virgen Macarena, Sevilla, Spain; Azucena Sanz, María Dolores Aguilar, Hospital Universitario La Paz, Madrid, Spain; Ana Molano, Maitena Lasa, Hospital de Cruces, Bilbao, Spain. Data management and biometrics: Josep Maria Sol, Francisco Hernández, Irune Quevedo, Anna Salvà, Verónica Alfonso, European Biometrics Institute, Barcelona, Spain. Administrative management: Carme Pla (deceased), Romina Ribas, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, and Behavioral Neurology Group, Institut Municipal d'Investigació Mèdica, Barcelona, Spain. English edition: Stephanie Lonsdale, Program of Neuropsychopharmacology, Institut Municipal d'Investigació Mèdica, Barcelona, Spain. Conflict of interest: None declared.

Notes

^†Recently deceased.