A deep learning algorithm to detect signs of cognitive impairment in electronic health records

阿尔茨海默病和相关痴呆症（AD/ADRD）的结果来自真实世界的数据，如电子 健康记录（EHR），提供了检查各种各样的研究问题的可能性，这些问题不能被 在其他环境中，回答效率很高，或者根本没有。一个关键的挑战是AD/ADRD在 社区，医疗保健专业人员诊断不足，索赔数据编码不足， 在任何情况下都是错误的。因此，依赖于痴呆症诊断代码或药物的方法遭受以下问题： 这些数据的不准确性。EHR在临床记录、患者健康史和健康方面具有丰富的信息 系统交互往往包含认知衰退的迹象。深度学习算法可以利用和 从EHR中的这些复杂文本和数据模式中学习。在本提案中，我们的目标是开发和评估一个 深度学习算法，以改善对潜在AD/ADRD所致认知障碍的检测 病理生理学（包括认知问题，轻度认知障碍和痴呆）使用EHR 三大医疗机构。对于算法的训练和评估，我们将使用“种子”参考 由专家临床医生对认知诊断进行详细的病历审查和裁定的标准集（n= 1，000）， 然后采用多样性抽样的主动学习策略，更好地反映美国老年人的特点， 成人，并迭代增加样本量至n= 20，000。我们将使用EHR严格评估算法 从所有三个机构，并制定公开提供的指导方针和资源，为研究界。 我们的具体目标是：1）开发和评估深度学习NLP工具，以识别具有认知障碍的患者 在一个机构使用EHR的障碍; 2）完善和评估我们的EHR深度学习的性能 算法在其他两个医疗机构;和3）开发开放的指南，资源和工具的电子健康记录 痴呆症研究中的数据使用。我们将衡量深度学习准确性的边际改进- 相对于仅基于诊断代码和药物的模型， 模型性能差的预测因子，以改进模型并了解潜在的偏差。因此，在本发明中， 我们的工具将提供一个更好的了解使用诊断代码和/或药物的局限性， 痴呆症研究尖端的深度学习算法已经应用于许多现实世界的任务，但在一个 对AD/ADRD的限制方式。我们预计，我们最先进的深度学习算法，这将是 在多个机构中使用大型代表性数据集进行严格开发和验证， 有效且准确地检测认知障碍的迹象，并且可以由从业者容易地部署。 改善EHR中认知障碍的筛查将加强痴呆症研究，并使大规模的 规模务实的足迹。在未来，我们希望，拟议的工具也将是有用的，在临床设置的标志 认知障碍患者，他们可以从评估中受益或被转诊到专科护理。

Alzheimer’s Disease and Related Dementias (AD/ADRD) outcomes from real-world data, such as electronic health records (EHR), offer the possibility of examining a wide variety of research questions that cannot be answered efficiently—or at all—in other settings. A key challenge is that AD/ADRD is under-recognized in the community, under-diagnosed by healthcare professionals, and under-coded in claims data—and can be mislabeled in any setting. Thus, approaches relying on dementia diagnosis codes or medications suffer from inaccuracies in these data. EHR has a wealth of information in clinical notes, patient health history, and health system interactions that often contain signs of cognitive decline. Deep learning algorithms can leverage and learn from these complex text and data patterns in EHR. In this proposal, we aim to develop and evaluate a deep learning algorithm to improve the detection of cognitive impairment due to underlying AD/ADRD pathophysiology (including cognitive concerns, mild cognitive impairment, and dementia) using the EHR of three large healthcare institutions. For training and evaluation of the algorithm, we will use a “seed” reference standard set with detailed chart review and adjudication of cognitive diagnosis by an expert clinician (n=1,000), and then apply active learning strategies with diversity sampling to better reflect the characteristics of US older adults and iteratively increase sample size to n=20,000. We will rigorously evaluate the algorithm using EHR from all three institutions, and develop openly available guidelines and resources for the research community. Our specific aims are: 1) To develop and evaluate a deep learning NLP tool to identify patients with cognitive impairment using EHR at one institution; 2) To refine and evaluate the performance of our EHR deep learning algorithm at two other healthcare institutions; and 3) To develop open guidelines, resources, and tools for EHR data use in dementia research. We will measure the marginal improvement in accuracy of our deep learning- based classification relative to models based on diagnosis codes and medications alone, and characterize the predictors of poor model performance, both to improve the model and to understand potential biases. As such, our tool will provide a better understanding of the limitations of using diagnosis codes and/or medications in dementia research. Cutting-edge deep learning algorithms have been applied to many real-world tasks but in a limited manner to AD/ADRD. We anticipate that our state-of-the-art deep learning algorithm, which will be rigorously developed and validated with large representative datasets at multiple institutions, will more efficiently and accurately detect signs of cognitive impairment and can be readily deployed by practitioners. Improved screening of cognitive impairment in EHR will enhance dementia research studies and enable large- scale pragmatic trails. In the future, we hope, the proposed tool will also be useful in clinical settings to flag patients with cognitive impairment who could benefit from an evaluation or be referred to specialist care.