Identifying Key Predictors of Cognitive Dysfunction in Older People Using Supervised Machine Learning Techniques: Observational Study

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Abstract

Background: Machine learning techniques, specifically classification algorithms, may be effective to help understand key health, nutritional, and environmental factors associated with cognitive function in aging populations. Objective: This study aims to use classification techniques to identify the key patient predictors that are considered most important in the classification of poorer cognitive performance, which is an early risk factor for dementia. Methods: Data were used from the Trinity-Ulster and Department of Agriculture study, which included detailed information on sociodemographic, clinical, biochemical, nutritional, and lifestyle factors in 5186 older adults recruited from the Republic of Ireland and Northern Ireland, a proportion of whom (987/5186, 19.03%) were followed up 5-7 years later for reassessment. Cognitive function at both time points was assessed using a battery of tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), with a score <70 classed as poorer cognitive performance. This study trained 3 classifiers-decision trees, Naïve Bayes, and random forests-to classify the RBANS score and to identify key health, nutritional, and environmental predictors of cognitive performance and cognitive decline over the follow-up period. It assessed their performance, taking note of the variables that were deemed important for the optimized classifiers for their computational diagnostics. Results: In the classification of a low RBANS score (<70), our models performed well (F1 score range 0.73-0.93), all highlighting the individual's score from the Timed Up and Go (TUG) test, the age at which the participant stopped education, and whether or not the participant's family reported memory concerns to be of key importance. The classification models performed well in classifying a greater rate of decline in the RBANS score (F1 score range 0.66-0.85), also indicating the TUG score to be of key importance, followed by blood indicators: plasma homocysteine, vitamin B6 biomarker (plasma pyridoxal-5-phosphate), and glycated hemoglobin. Conclusions: The results suggest that it may be possible for a health care professional to make an initial evaluation, with a high level of confidence, of the potential for cognitive dysfunction using only a few short, noninvasive questions, thus providing a quick, efficient, and noninvasive way to help them decide whether or not a patient requires a full cognitive evaluation. This approach has the potential benefits of making time and cost savings for health service providers and avoiding stress created through unnecessary cognitive assessments in low-risk patients.

Original languageEnglish
Article numbere20995
Pages (from-to)1-23
Number of pages23
JournalJMIR Medical Informatics
Volume8
Issue number9
DOIs
Publication statusPublished - 16 Sep 2020

Bibliographical note

Funding Information:
The authors would like to acknowledge the support of the eHealth and Data Analytics Dementia Pathfinder Programme and the HSCB eHealth Directorate in this work, under Award 15F-1701. This work was supported by the Irish Department of Agriculture, Food and the Marine and Health Research Board (under the Food Institutional Research Measure) and by the Northern Ireland Department for Employment and Learning (under its Strengthening the All-Island Research Base initiative). The funders of this research had no role in the design, methods, data collection and analysis, or preparation of the paper.

Publisher Copyright:
© 2020 Debbie Rankin, Michaela Black, Bronac Flanagan, Catherine F Hughes, Adrian Moore, Leane Hoey, Jonathan Wallace, Chris Gill, Paul Carlin, Anne M Molloy, Conal Cunningham, Helene McNulty.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • classification
  • supervised machine learning
  • cognition
  • diet
  • aging
  • geriatric assessment

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