Deep Learning for Classifying and Cognitive Profiling of Subcortical Vascular Cognitive Impairment

Subcortical vascular cognitive impairment (SVCI) is a heterogeneous cognitive impairment caused by small vessel disease. Diagnosis of SVCI remains challenging when neuropsychological assessment is impractical. This study proposes a diffusion tensor imaging (DTI)-based DenseNet to identify SVCI from subcortical ischemic vascular disease (SIVD) and to profile multidomain cognitive risks. We collected neuropsychological scales and DTI from 134 SVCI and 171 SIVD patients in our internal dataset for model development. An external target-domain dataset of 90 SVCI and 103 SIVD patients was used for unsupervised domain adaptation (UDA). Within this dataset, 45 SVCI and 53 SIVD patients were used for unlabeled UDA fitting; the remaining 45 SVCI and 50 SIVD patients were held out as a target-domain test set. Model-generated salient maps identified white matter (WM) regions associated with SVCI. Mutual information (MI) maps between DTI and 6 neuropsychological scales were computed to identify structural correlates of cognitive domains for cognitive profiling. We computed structural similarity index measure (SSIM) between individual-level salient maps derived from DenseNet and the MI maps for unsupervised clustering to stratify domain-specific cognitive impairment risk in SVCI. The DenseNet achieves high accuracy (0.902 internal, 0.926 target-domain) with AUCs of 0.951 and 0.942, respectively. SVCI probabilities reflect cognitive severity, and salient maps are associated with neuropsychological performance. Regarding cognitive profiling, each cognitive domain is divided into low, moderate, and high subgroups, with significantly different SSIM. Our DTI-based study demonstrates accurate SVCI identification and individualized multi-domain cognitive profiling. This offers a complementary framework to support diagnosis and personalized intervention.