Useful Blunders: Can Automated Speech Recognition Errors Improve Downstream Dementia Classification?

\textbf{Objectives}: We aimed to investigate how errors from automatic speech recognition (ASR) systems affect dementia classification accuracy, specifically in the ``Cookie Theft'' picture description task. We aimed to assess whether imperfect ASR-generated transcripts could provide valuable information for distinguishing between language samples from cognitively healthy individuals and those with Alzheimer's disease (AD). \textbf{Methods}: We conducted experiments using various ASR models, refining their transcripts with post-editing techniques. Both these imperfect ASR transcripts and manually transcribed ones were used as inputs for the downstream dementia classification. We conducted comprehensive error analysis to compare model performance and assess ASR-generated transcript effectiveness in dementia classification. \textbf{Results}: Imperfect ASR-generated transcripts surprisingly outperformed manual transcription for distinguishing between individuals with AD and those without in the ``Cookie Theft'' task. These ASR-based models surpassed the previous state-of-the-art approach, indicating that ASR errors may contain valuable cues related to dementia. The synergy between ASR and classification models improved overall accuracy in dementia classification. \textbf{Conclusion}: Imperfect ASR transcripts effectively capture linguistic anomalies linked to dementia, improving accuracy in classification tasks. This synergy between ASR and classification models underscores ASR's potential as a valuable tool in assessing cognitive impairment and related clinical applications.

Backdoor Adjustment of Confounding by Provenance for Robust Text Classification of Multi-institutional Clinical Notes

Natural Language Processing (NLP) methods have been broadly applied to clinical tasks. Machine learning and deep learning approaches have been used to improve the performance of clinical NLP. However, these approaches require sufficiently large datasets for training, and trained models have been shown to transfer poorly across sites. These issues have led to the promotion of data collection and integration across different institutions for accurate and portable models. However, this can introduce a form of bias called confounding by provenance. When source-specific data distributions differ at deployment, this may harm model performance. To address this issue, we evaluate the utility of backdoor adjustment for text classification in a multi-site dataset of clinical notes annotated for mentions of substance abuse. Using an evaluation framework devised to measure robustness to distributional shifts, we assess the utility of backdoor adjustment. Our results indicate that backdoor adjustment can effectively mitigate for confounding shift.

A Dialogue System for Assessing Activities of Daily Living: Improving Consistency with Grounded Knowledge

In healthcare, the ability to care for oneself is reflected in the "Activities of Daily Living (ADL)," which serve as a measure of functional ability (functioning). A lack of functioning may lead to poor living conditions requiring personal care and assistance. To accurately identify those in need of support, assistance programs continuously evaluate participants' functioning across various domains. However, the assessment process may encounter consistency issues when multiple assessors with varying levels of expertise are involved. Novice assessors, in particular, may lack the necessary preparation for real-world interactions with participants. To address this issue, we developed a dialogue system that simulates interactions between assessors and individuals of varying functioning in a natural and reproducible way. The dialogue system consists of two major modules, one for natural language understanding (NLU) and one for natural language generation (NLG), respectively. In order to generate responses consistent with the underlying knowledge base, the dialogue system requires both an understanding of the user's query and of biographical details of an individual being simulated. To fulfill this requirement, we experimented with query classification and generated responses based on those biographical details using some recently released InstructGPT-like models.

TRESTLE: Toolkit for Reproducible Execution of Speech, Text and Language Experiments

The evidence is growing that machine and deep learning methods can learn the subtle differences between the language produced by people with various forms of cognitive impairment such as dementia and cognitively healthy individuals. Valuable public data repositories such as TalkBank have made it possible for researchers in the computational community to join forces and learn from each other to make significant advances in this area. However, due to variability in approaches and data selection strategies used by various researchers, results obtained by different groups have been difficult to compare directly. In this paper, we present TRESTLE (\textbf{T}oolkit for \textbf{R}eproducible \textbf{E}xecution of \textbf{S}peech \textbf{T}ext and \textbf{L}anguage \textbf{E}xperiments), an open source platform that focuses on two datasets from the TalkBank repository with dementia detection as an illustrative domain. Successfully deployed in the hackallenge (Hackathon/Challenge) of the International Workshop on Health Intelligence at AAAI 2022, TRESTLE provides a precise digital blueprint of the data pre-processing and selection strategies that can be reused via TRESTLE by other researchers seeking comparable results with their peers and current state-of-the-art (SOTA) approaches.

The Far Side of Failure: Investigating the Impact of Speech Recognition Errors on Subsequent Dementia Classification

Linguistic anomalies detectable in spontaneous speech have shown promise for various clinical applications including screening for dementia and other forms of cognitive impairment. The feasibility of deploying automated tools that can classify language samples obtained from speech in large-scale clinical settings depends on the ability to capture and automatically transcribe the speech for subsequent analysis. However, the impressive performance of self-supervised learning (SSL) automatic speech recognition (ASR) models with curated speech data is not apparent with challenging speech samples from clinical settings. One of the key questions for successfully applying ASR models for clinical applications is whether imperfect transcripts they generate provide sufficient information for downstream tasks to operate at an acceptable level of accuracy. In this study, we examine the relationship between the errors produced by several deep learning ASR systems and their impact on the downstream task of dementia classification. One of our key findings is that, paradoxically, ASR systems with relatively high error rates can produce transcripts that result in better downstream classification accuracy than classification based on verbatim transcripts.

GPT-D: Inducing Dementia-related Linguistic Anomalies by Deliberate Degradation of Artificial Neural Language Models

Deep learning (DL) techniques involving fine-tuning large numbers of model parameters have delivered impressive performance on the task of discriminating between language produced by cognitively healthy individuals, and those with Alzheimer's disease (AD). However, questions remain about their ability to generalize beyond the small reference sets that are publicly available for research. As an alternative to fitting model parameters directly, we propose a novel method by which a Transformer DL model (GPT-2) pre-trained on general English text is paired with an artificially degraded version of itself (GPT-D), to compute the ratio between these two models' \textit{perplexities} on language from cognitively healthy and impaired individuals. This technique approaches state-of-the-art performance on text data from a widely used "Cookie Theft" picture description task, and unlike established alternatives also generalizes well to spontaneous conversations. Furthermore, GPT-D generates text with characteristics known to be associated with AD, demonstrating the induction of dementia-related linguistic anomalies. Our study is a step toward better understanding of the relationships between the inner workings of generative neural language models, the language that they produce, and the deleterious effects of dementia on human speech and language characteristics.

A Conversational Agent System for Dietary Supplements Use

Dietary supplements (DS) have been widely used by consumers, but the information around the effectiveness and safety of DS is disparate or incomplete, making barriers to consumers to find information effectively. Conversational agent systems have been applied to the healthcare domain but there is no such a system to answer consumers regarding DS use, although widespread use of the dietary supplement. In this study, we develop the first conversational agent system for DS use.

A Tale of Two Perplexities: Sensitivity of Neural Language Models to Lexical Retrieval Deficits in Dementia of the Alzheimer's Type

In recent years there has been a burgeoning interest in the use of computational methods to distinguish between elicited speech samples produced by patients with dementia, and those from healthy controls. The difference between perplexity estimates from two neural language models (LMs) - one trained on transcripts of speech produced by healthy participants and the other trained on transcripts from patients with dementia - as a single feature for diagnostic classification of unseen transcripts has been shown to produce state-of-the-art performance. However, little is known about why this approach is effective, and on account of the lack of case/control matching in the most widely-used evaluation set of transcripts (DementiaBank), it is unclear if these approaches are truly diagnostic, or are sensitive to other variables. In this paper, we interrogate neural LMs trained on participants with and without dementia using synthetic narratives previously developed to simulate progressive semantic dementia by manipulating lexical frequency. We find that perplexity of neural LMs is strongly and differentially associated with lexical frequency, and that a mixture model resulting from interpolating control and dementia LMs improves upon the current state-of-the-art for models trained on transcript text exclusively.