Improved automatic speech-based cognitive assessment using neuropsychologically calibrated diagnostic labels

Abstract

Although automatic detection of cognitive impairment from conversational speech is a promising way, it becomes less accurate, as large real-world datasets often contain unreliable diagnostic labels due to self-referral and limited clinical verification, and here we investigated whether neuropsychologically calibrated diagnostic relabeling improves it. We analysed 138 hours of conversational speech from 720 participants, recalibrating unreliable diagnostic labels using attention, executive function, and memory performance via external clinical thresholds, Gaussian, and normative z-score calibration. Transformer-based classifiers were trained using both original and recalibrated labels and evaluated internally on 150 clinically verified participants and externally on Pitt, ADReSS and PROCESS-2 datasets. Memory- and MoCA-based z-score calibration produced the greatest improvements. Using our internal dataset, $F_1$ increased from $0.70$ to $0.83$ ($+13\%$) and from $0.54$ to $0.66$ ($+12\%$) for binary and multiclass classification, respectively. For external validation, the increases are $+4\%$, $+5\%$ and $+9\%$ on Pitt, ADReSS and PROCESS-2 corpus. Neuropsychologically calibrated relabeling substantially improves speech-based cognitive assessment, highlighting label quality, rather than model architecture, as a critical bottleneck in clinical AI for dementia screening.