Cross-Lingual Alzheimer's Disease Speech Detection: Polarity Inversion and Few-Shot Calibration Strategies

Speech-based non-invasive screening offers a cost-effective and scalable approach for the early detection of Alzheimer's disease (AD). However, the clinical utility of deep learning models remains severely constrained by the scarcity of labeled speech data in low-resource languages, necessitating cross-lingual transfer learning. Conventional domain adaptation paradigms typically assume semantically consistent feature domains and focus heavily on aligning marginal distributions; however, they suffer catastrophic performance degradation when applied to cross-lingual pathologic speech. By analyzing disease-associated representation vectors within a self-supervised HuBERT space, we uncover a systematic mechanism driving this failure, a phenomenon we term cross-lingual polarity flip, where the direction of disease-relative-to-control feature offsets fundamentally reverses between languages. While prior multilingual studies have largely discarded such dimensional inconsistencies as ungeneralizable noise, a 500-round Monte Carlo stability analysis demonstrates that these flips occur in a highly stable, structural manner across 18.3% of top discriminative dimensions. Leveraging this insight, we introduce Monte Carlo Polarity Flip Calibration (MC-PFC), a few-shot framework designed to explicitly rectify flip orientations. Requiring only five labeled support samples per class from the target domain, MC-PFC robustly estimates direction flips via a separability-weighted ensemble voting mechanism. Evaluated on a strictly held-out Chinese blind test set, MC-PFC achieves an area under the receiver operating characteristic curve (AUC) of 0.871, recovering 99.5% of the performance achieved by a full in-domain trained upper bound (AUC = 0.875). Ablation experiments confirm that direction calibration yields a substantial +0.361 AUC gain, vastly outperforming standard distribution alignment (+0.081). This work establishes a data-efficient paradigm for cross-lingual medical analysis, shifting the clinical AI focus from discarding cross-lingual discrepancies to actively modeling and calibrating them.