Neuropsychological exams are commonly used to diagnose various kinds of cognitive impairment. They typically involve a trained examiner who conducts a series of cognitive tests with a subject. In recent years, there has been growing interest in developing machine learning methods to extract speech and language biomarkers from exam recordings to provide automated input for cognitive assessment. Inspired by recent findings suggesting that the examiner’s language can influence cognitive impairment classifications, in this paper, we study the influence of the examiner on automatic dementia identification decisions in real-world neuropsychological exams. To mitigate the influence of the examiner, we propose a systematic three-stage pipeline for detecting dementia from exam recordings. In the first stage, we perform audio-based speaker diarization (i.e., estimating who spoke when?) by incorporating speaker discriminative features. In the second stage, we employ text-based language models to identify the role of the speaker (i.e., examiner or subject). Finally, in the third stage, we employ text- and audio-based models to detect cognitive impairment from hypothesized subject segments. Our studies suggest that incorporating audio-based diarization followed by text-based role identification helps mitigate the influences from the examiner’s segments. Further, we found that the text and audio modalities complement each other, and the performance improves when we use both modalities. We also perform several carefully designed experimental studies to assess the performance of each stage.

Neuropsychological examinations are an important screening tool for the presence of cognitive conditions (e.g. Alzheimer’s, Parkinson’s Disease), and require a trained tester to conduct the exam through spoken interactions with the subject. While audio is relatively easy to record, it remains a challenge to automatically diarize (who spoke when?), decode (what did they say?), and assess a subject’s cognitive health. This paper demonstrates a method to determine the cognitive health (impaired or not) of 92 subjects, from audio that was diarized using an automatic speech recognition system trained on TED talks and on the structured language used by testers and subjects. Using leave-one-out cross validation and logistic regression modeling we show that even with noisily decoded data (81% WER) we can still perform accurate enough diarization (0.02% confusion rate) to determine the cognitive state of a subject (0.76 AUC).