A whole-process interpretable and multi-modal deep reinforcement learning for diagnosis and analysis of Alzheimer’s disease ∗ ∗ Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or

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Objective. Alzheimer’s disease (AD), a common disease of the elderly with unknown etiology, has been adversely affecting many people, especially with the aging of the population and the younger trend of this disease. Current artificial intelligence (AI) methods based on individual information or magnetic resonance imaging (MRI) can solve the problem of diagnostic sensitivity and specificity, but still face the challenges of interpretability and clinical feasibility. In this study, we propose an interpretable multimodal deep reinforcement learning model for inferring pathological features and the diagnosis of AD. Approach. First, for better clinical feasibility, the compressed-sensing MRI image is reconstructed using an interpretable deep reinforcement learning model. Then, the reconstructed MRI is input into the full convolution neural network to generate a pixel-level disease probability risk map (DPM) of the whole brain for AD. The DPM of important brain regions and individual information are then input into the attention-based fully deep neural network to obtain the diagnosis results and analyze the biomarkers. We used 1349 multi-center samples to construct and test the model. Main results. Finally, the model obtained 99.6% ± 0.2%, 97.9% ± 0.2%, and 96.1% ± 0.3% area under curve in ADNI, AIBL and NACC, respectively. The model also provides an effective analysis of multimodal pathology, predicts the imaging biomarkers in MRI and the weight of each individual item of information. In this study, a deep reinforcement learning model was designed, which can not only accurately diagnose AD, but analyze potential biomarkers. Significance. In this study, a deep reinforcement learning model was designed. The model builds a bridge between clinical practice and AI diagnosis and provides a viewpoint for the interpretability of AI technology.