Multimodal Imaging and Logistic Weighted Cognitive Scores for Classification of MCI, AD, and FTD Subtypes

Abstract

BackgroundDifferentiating between mild cognitive impairment (MCI), Alzheimers disease (AD), and frontotemporal dementia (FTD) subtypes remains a clinical challenge due to overlapping cognitive symptoms, structural atrophy, and metabolic patterns, especially in the early stages. Multimodal classification approaches integrating neuroimaging and cognitive scores may offer early and accurate characterization and subsequently improved diagnostic precision. MethodsIn this study, we included 100 participants (50 AD, 30 FTD, including 14 bvFTD and 16 PPA, and 20 MCI) who underwent simultaneous structural MRI and FDG-PET imaging. Cortical thickness (CTH) from anatomical MRI and standardized uptake values from FDG-PET were extracted using FreeSurfer and PETSurfer pipelines, respectively. CTH and FDG-PET features were combined into a single vector through a logistic weighting function derived from ACE-III scores, capturing the progressive nature of cognitive decline in dementia. A Naive Bayes classifier was then trained to differentiate diagnostic groups based on the merged features. ResultsThe model achieved classification accuracies of 83% for MCI vs. dementia (AD + FTD), 85% for MCI vs. FTD, 87% for MCI vs. PPA, 71% for MCI vs. bvFTD, 64% for MCI vs. AD, and 69% for AD vs. FTD. The overall classification accuracy was 68%, with the highest discriminative performance observed in separating MCI from FTD subtypes. ConclusionsThis study presents a novel, cognition-weighted multimodal approach combining structural and metabolic imaging to enhance the classification of neurodegenerative syndromes. Findings from this study, underscore the potential of integrating ACE-III scores with neuroimaging biomarkers for accurate characterization and, early-stage differentiation of MCI, AD, and FTD variants.