The ICN-UN Battery: A Machine Learning-Optimized Tool for Expeditious Alzheimer's Disease Diagnosis

Abstract

Background/Objectives: Alzheimer's disease (AD) accounts for ~70% of global dementia cases, with projections estimating 139 million affected individuals by 2050. This increasing burden highlights the urgent need for accessible, cost-effective diagnostic tools, particularly in low- and middle-income countries (LMICs). Traditional neuropsychological assessments, while effective, are resource-intensive and time-consuming. Methods: A total of 760 older adults (394 [51.8%] with AD) were recruited and neuropsychologically evaluated at the Instituto Colombiano de Neuropedagogía (ICN) in collaboration with Universidad del Norte (UN), Barranquilla. Machine learning (ML) algorithms were trained on a screening protocol incorporating demographic data and neuropsychological measures assessing memory, language, executive function, and praxis. Model performance was determined using 10-fold cross-validation. Variable importance analyses identified key predictors to develop optimized, abbreviated ML-based protocols. Metrics of compactness, cohesion, and separation further quantified diagnostic differentiation performance. Results: The eXtreme Gradient Boosting (xgbTree) algorithm achieved the highest diagnostic accuracy (91%) with the full protocol. Five ML-optimized screening protocols were also developed. The most efficient, the ICN-UN battery (including MMSE, Rey-Osterrieth Complex Figure recall, Rey Auditory Verbal Learning, Lawton & Brody Scale, and FAST), maintained strong diagnostic performance while reducing screening time from over four hours to under 25 min. Conclusions: The ML-optimized ICN-UN protocol offers a rapid, accurate, and scalable AD screening solution for LMICs. While promising for clinical adoption and earlier detection, further validation in diverse populations is recommended.