Abstract
Detecting cognitive decline earlier among older adults can facilitate enrollment in clinical trials and early interventions. Clinical notes in longitudinal electronic health records (EHRs) provide opportunities to detect cognitive decline earlier than it is noted in structured EHR fields as formal diagnoses. To develop and validate a deep learning model to detect evidence of cognitive decline from clinical notes in the EHR. Notes documented 4 years preceding the initial mild cognitive impairment (MCI) diagnosis were extracted from Mass General Brigham's Enterprise Data Warehouse for patients aged 50 years or older and with initial MCI diagnosis during 2019. The study was conducted from March 1, 2020, to June 30, 2021. Sections of notes for cognitive decline were labeled manually and 2 reference data sets were created. Data set I contained a random sample of 4950 note sections filtered by a list of keywords related to cognitive functions and was used for model training and testing. Data set II contained 2000 randomly selected sections without keyword filtering for assessing whether the model performance was dependent on specific keywords. A deep learning model and 4 baseline models were developed and their performance was compared using the area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC). Data set I represented 1969 patients (1046 [53.1%] women; mean [SD] age, 76.0 [13.3] years). Data set II comprised 1161 patients (619 [53.3%] women; mean [SD] age, 76.5 [10.2] years). With some overlap of patients deleted, the unique population was 2166. Cognitive decline was noted in 1453 sections (29.4%) in data set I and 69 sections (3.45%) in data set II. Compared with the 4 baseline models, the deep learning model achieved the best performance in both data sets, with AUROC of 0.971 (95% CI, 0.967-0.976) and AUPRC of 0.933 (95% CI, 0.921-0.944) for data set I and AUROC of 0.997 (95% CI, 0.994-0.999) and AUPRC of 0.929 (95% CI, 0.870-0.969) for data set II. In this diagnostic study, a deep learning model accurately detected cognitive decline from clinical notes preceding MCI diagnosis and had better performance than keyword-based search and other machine learning models. These results suggest that a deep learning model could be used for earlier detection of cognitive decline in the EHRs.
Highlights
There are nearly 6 million people diagnosed with Alzheimer disease (AD) at the stage of dementia in the US, and the prevalence increases dramatically with age.[1]
Compared with the 4 baseline models, the deep learning model achieved the best performance in both data sets, with area under the receiver operating characteristic curve (AUROC) of 0.971 and area under the precision recall curve (AUPRC) of 0.933 for data set I and AUROC of 0.997 and AUPRC of 0.929 for data set II
In this diagnostic study, a deep learning model accurately detected cognitive decline from clinical notes preceding mild cognitive impairment (MCI) diagnosis and had better performance than keyword-based search and other machine learning models. These results suggest that a deep learning model could be used for earlier detection of cognitive decline in the electronic health records (EHRs)
Summary
There are nearly 6 million people diagnosed with Alzheimer disease (AD) at the stage of dementia in the US, and the prevalence increases dramatically with age.[1]. Mild cognitive impairment (MCI) and subjective cognitive decline (SCD) represent precursor stages that can serve as targets for early treatment.[2-4]. Detection of cognitive decline can facilitate enrollment in clinical trials and early interventions.[5,6]. The US Food and Drug Administration recently approved aducanumab, a drug directed at the underlying pathologic characteristics of AD that clears amyloid plaques in the brain, to treat patients with AD.[7]. Detecting patients with cognitive decline is challenging. There is an insufficient number of specialists with the necessary expertise (behavioral or cognitive neurologists, geriatric psychiatrists, geriatricians, and neuropsychologists) to see all at-risk patients. Primary care physicians and other nondementia specialists have direct contact with these patients but not necessarily the time or tools needed for diagnosis.[8]
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