Knowledge-Guided Deep Learning with Clinical EEG Biomarkers for Automated Dementia Detection and Staging

Background: Early detection of dementia is essential for timely intervention, yet existing diagnostic approaches remain costly, invasive, or dependent on specialized expertise. Electroencephalography (EEG) offers a non-invasive and accessible alternative; however, purely data-driven deep learning models may overlook clinically established neurophysiological biomarkers, particularly in the challenging detection of mild cognitive impairment (MCI). Methods: We propose the Clinical EEG Feature-Augmented Network (CEFA-Net), a knowledge-guided deep learning framework that systematically integrates automatic representation learning from raw multichannel EEG with clinically validated neurophysiological biomarkers. The architecture combines three complementary convolutional pathways capturing multi-scale temporal dynamics with domain-informed feature representations, enabling both data-driven discovery and clinically grounded interpretation. Task-specific optimization strategies-including focal loss, class-aware augmentation, and validation-guided ensemble weighting-were employed to enhance robustness under class imbalance. The model was evaluated on the large-scale the Chung-Ang University Hospital EEG (CAUEEG) dataset (1379 recordings from 1155 patients) across binary abnormality detection and three-class dementia staging tasks. Results: CEFA-Net achieved 81.02% accuracy (macro F1: 81.15%) for dementia staging and 87.15% accuracy (macro F1: 87.41%) for abnormality detection, outperforming baseline methods by 6.75-9.10 percentage points (p < 0.001). Notably, the proposed framework substantially improved MCI detection (F1-score: 78%), representing a 14-point gain over traditional machine learning approaches. Ablation analyses confirmed that clinical biomarker integration and multi-model fusion provide complementary diagnostic value. In an additional patient-disjoint evaluation using the no-overlap partitions, CEFA-Net achieved 85.40% accuracy for abnormality detection and 73.80% accuracy for dementia staging, demonstrating generalization to subjects completely excluded from the training data. Conclusions: These findings demonstrate that knowledge-guided integration of clinical biomarkers with deep representation learning can significantly enhance EEG-based dementia detection. CEFA-Net offers a clinically aligned and computationally efficient solution, supporting its potential for real-world screening and early diagnostic workflows.