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Clinical Manifestations.

Liqin Wang1, Rebecca E Amariglio2, Li Zhou1

  • 1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
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Summary

Large language models (LLMs) can identify subjective cognitive decline (SCD) in electronic health records. This study highlights common cognitive concerns like memory issues in patients with SCD.

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Area of Science:

  • Neurology
  • Artificial Intelligence
  • Medical Informatics

Background:

  • Subjective cognitive decline (SCD) represents early memory or cognitive concerns despite normal test performance, crucial for early intervention.
  • SCD is often missed due to lack of standardized codes and reliance on free-text electronic health records (EHR).
  • Limited research exists on SCD patient characteristics and documented cognitive concerns.

Purpose of the Study:

  • To investigate the feasibility of using large language models (LLMs) to identify and characterize cognitive concerns in patients with presumed SCD.
  • To analyze the common themes and sub-themes of cognitive concerns documented in EHRs for patients with normal cognitive test scores.

Main Methods:

  • Retrospective cohort study analyzing EHR data from Mass General Brigham (MGB) for patients aged 65+ with initial cognitive assessments.
  • A two-tiered LLM approach (Med42-v2-8B and GPT-4o) was employed to identify cognitive concerns in clinical notes.
  • GPT-4o was used to summarize themes and sub-themes, with statistical analyses comparing patient groups.

Main Results:

  • The study included 15,750 patients; 13.8% (2,175) had identified cognitive concerns or SCD.
  • LLMs identified 12 major themes and 34 sub-themes of cognitive concerns.
  • Most frequent themes included memory issues (69.7%), cognitive processing/speed (26.5%), confusion/disorientation (25.3%), and language problems (23.8%).

Conclusions:

  • LLMs are effective in extracting and classifying cognitive concerns in patients with presumed SCD.
  • The identified themes offer valuable insights into the nature of early cognitive issues.
  • Future research should link these symptoms to dementia progression.