Personalised treatment for cognitive impairment in dementia: development and validation of an artificial intelligence model.
Personalised treatment for cognitive impairment in dementia: development and validation of an artificial intelligence model.
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DOI：
10.1186/s12916-022-02250-2
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发表时间：
2022-02-01
期刊：
影响因子：
9.3
通讯作者：
Nevado-Holgado A
中科院分区：
文献类型：
--
作者：
Liu Q;Vaci N;Koychev I;Kormilitzin A;Li Z;Cipriani A;Nevado-Holgado A
多奈哌齐、加兰他敏、卡巴拉汀和美金刚是治疗痴呆症认知障碍的潜在有效干预措施，但这些药物的使用尚未个性化。我们研究了基于人工智能的建议是否可以使用常规收集的患者信息来确定最佳治疗方法。6804例年龄在59-102岁之间，诊断为痴呆症的患者来自英国的两个国家卫生服务（NHS）基金会信托基金，分别用于模型训练/内部验证和外部验证。开发了基于递归神经网络机器学习架构的个性化处方模型，以预测药物开始后的简易精神状态检查（MMSE）和蒙特利尔认知评估（莫卡）评分。选择在处方和下一次访视之间导致认知评分下降最小的药物作为首选治疗。比较治疗开始后2年内认知评分的变化，以进行模型评价。总体而言，1343例MMSE评分的患者被确定为内部验证，285例[21.22%]接受了推荐的药物。2年后，该组患者的平均[标准差] MMSE评分下降幅度显著小于其余1058例[78.78%]患者（0.60 [0.26] vs 2.80 [0.28]; P = 0.02）。在外部验证队列（N = 1772）中，222例[12.53%]患者服用了推荐的药物，与1550例[87.47%]未服用的患者相比，MMSE降低较小（1.01 [0.49] vs 4.23 [0.60]; P = 0.01）。在仅使用AChEI处方的患者上测试模型时，也发现了类似的性能差距。有可能在个体患者水平上确定最有效的药物用于痴呆症认知障碍的现实治疗。根据该模型，处方药物最适合的常规护理患者在2年后具有更好的认知表现。在线版本包含补充材料，可通过10.1186/s12916-022-02250-2获得。
Donepezil, galantamine, rivastigmine and memantine are potentially effective interventions for cognitive impairment in dementia, but the use of these drugs has not been personalised to individual patients yet. We examined whether artificial intelligence-based recommendations can identify the best treatment using routinely collected patient-level information. Six thousand eight hundred four patients aged 59–102 years with a diagnosis of dementia from two National Health Service (NHS) Foundation Trusts in the UK were used for model training/internal validation and external validation, respectively. A personalised prescription model based on the Recurrent Neural Network machine learning architecture was developed to predict the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores post-drug initiation. The drug that resulted in the smallest decline in cognitive scores between prescription and the next visit was selected as the treatment of choice. Change of cognitive scores up to 2 years after treatment initiation was compared for model evaluation. Overall, 1343 patients with MMSE scores were identified for internal validation and 285 [21.22%] took the drug recommended. After 2 years, the reduction of mean [standard deviation] MMSE score in this group was significantly smaller than the remaining 1058 [78.78%] patients (0.60 [0.26] vs 2.80 [0.28]; P = 0.02). In the external validation cohort (N = 1772), 222 [12.53%] patients took the drug recommended and reported a smaller MMSE reduction compared to the 1550 [87.47%] patients who did not (1.01 [0.49] vs 4.23 [0.60]; P = 0.01). A similar performance gap was seen when testing the model on patients prescribed with AChEIs only. It was possible to identify the most effective drug for the real-world treatment of cognitive impairment in dementia at an individual patient level. Routine care patients whose prescribed medications were the best fit according to the model had better cognitive performance after 2 years. The online version contains supplementary material available at 10.1186/s12916-022-02250-2.
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影响因子：
3
作者：
Kumar S;Sharma R;Tsunoda T;Kumarevel T;Sharma A
通讯作者：
Sharma A
DOI：
10.1177/1471301217710531
发表时间：
2019-04-01
影响因子：
2.4
作者：
Evans, Simon C.;Garabedian, Claire;Bray, Jennifer
通讯作者：
Bray, Jennifer
影响因子：
2.1
作者：
Kumar S;Oh I;Schindler S;Lai AM;Payne PRO;Gupta A
通讯作者：
Gupta A
影响因子：
3.7
作者：
Gehrmann S;Dernoncourt F;Li Y;Carlson ET;Wu JT;Welt J;Foote J Jr;Moseley ET;Grant DW;Tyler PD;Celi LA
通讯作者：
Celi LA
影响因子：
4.2
作者：
Bae J;Stocks J;Heywood A;Jung Y;Jenkins L;Hill V;Katsaggelos A;Popuri K;Rosen H;Beg MF;Wang L;Alzheimer's Disease Neuroimaging Initiative
通讯作者：
Alzheimer's Disease Neuroimaging Initiative