Merna Bibars, Bolaji Omofojoye, Allan I. Levey +3cs.CV cs.AI
Depression and anxiety in older adults with Mild Cognitive Impairment (MCI) are frequently underdiagnosed due to limited access to care. Multimodal analysis of remote clinical interviews is a scalable screening approach, but existing methods have three limitations. First, they do not correct temporal misalignment across multimodal features extracted at different resolutions, inducing spurious cross-modal associations. Second, remote recordings exhibit uneven modality dropout, but missing values are often zero-filled, making them indistinguishable from valid near-zero measurements. Finally, they do not jointly attribute predictions to modalities, questions, and interview moments, limiting fine-grained clinical interpretation. We propose a Temporally-Aligned, Missingness-Aware, Interpretable (TAMI) multimodal fusion framework. TAMI aligns speech, language, facial, and physiological features within question-answer segments on a shared timeline, encodes modality-level missingness over time, and conditions fusion on question context. In interviews with 49 older adults with MCI, TAMI achieved area under the receiver operating characteristic curve (AUROC) scores of 0.68 (depression) and 0.69 (anxiety). Fine-grained temporal alignment of multimodal features produced the largest performance gain ($Δ{\geq}0.1$). Multi-level interpretability analysis revealed that depression classification relied on eyegaze and open-ended questions, while anxiety classification depended on eyegaze and head pose, with attribution uniformly distributed across questions. Using only responses to the open-ended questions (5.1min), the depression model achieved an AUROC score of 0.67, which was not significantly different from using the full interview (19min) ($p>0.05$). Our findings support designing interview protocols centered on open-ended questions for depression screening in older adults with MCI.
Early and scalable detection of mild cognitive impairment (MCI) remains an unresolved clinical challenge. Existing EEG-based screening approaches are constrained by handcrafted feature pipelines that discard neurophysiologically meaningful domain structure and deep learning classifiers that sacrifice interpretability for performance. No existing work unifies physiologically organized concept encoders, cross-concept interaction modeling, and nonlinear tabular classification in a sleep EEG-based MCI detection framework. This study proposes Concept-guided Polynomial-transformed Tabular learning using Kolmogorov-Arnold Network (CPTabKAN), which maps heterogeneous EEG-derived features into domain-informed concept representations, expands them via degree-2 polynomial transformation to expose first- and second-order interactions, and applies a Fourier-parameterized TabKAN classifier to learn nonlinear decision boundaries. CPTabKAN was evaluated on the Study of Osteoporotic Fractures cohort (372 subjects, overnight polysomnography), using 1,379 features organized into ten physiologically motivated concept groups. Under 10-fold cross-validation, CPTabKAN-Second Order achieved a weighted F1-score of 0.9038 (SD 0.034), outperforming GradientBoosting by 5.65 percentage points (t(9)=1.934,p=0.043, one-sided paired test), with advantages persisting under SMOTE-based balancing. Ablation analysis confirmed independent contributions from each component. Concept importance analysis revealed that power spectral density, multi-scale entropy, and Hjorth parameters dominated first-order weights, while cross-concept interactions involving Lempel-Ziv-Welch complexity, statistics, demographics, and slow oscillations exceeded all first-order scores. These results demonstrate that concept-structured, interaction-aware tabular learning surfaces physiologically coherent reasoning, supporting clinical trust.