# Speech-Based Cognitive Screening: A Systematic Evaluation of LLM Adaptation Strategies

arXiv: https://arxiv.org/abs/2509.03525 · HTML: https://mlsanity.com/paper/2509.03525/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 16 of its 63 references that are in the map.
- First posted on arXiv 24 Aug 2025.

## Builds on (most cited first, 16 of 16)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Efficient Estimation of Word Representations in Vector Space](https://mlsanity.com/paper/1301.3781/) (2013)
- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [Tree of Thoughts: Deliberate Problem Solving with Large Language Models](https://mlsanity.com/paper/2305.10601/) (2023)
- [M3-Embedding: Multi-Linguality, Multi-Functionality, Multi-Granularity Text Embeddings Through Self-Knowledge Distillation](https://mlsanity.com/paper/2402.03216/) (2024)
- [Qwen2.5-Omni Technical Report](https://mlsanity.com/paper/2503.20215/) (2025)
- [Phi-4-Mini Technical Report: Compact yet Powerful Multimodal Language Models via Mixture-of-LoRAs](https://mlsanity.com/paper/2503.01743/) (2025)
- [MedAlpaca -- An Open-Source Collection of Medical Conversational AI Models and Training Data](https://mlsanity.com/paper/2304.08247/) (2023)
- [Alzheimer's Disease Detection from Spontaneous Speech through Combining Linguistic Complexity and (Dis)Fluency Features with Pretrained Language Models](https://mlsanity.com/paper/2106.08689/) (2021)
- [Enhanced Large Language Models for Effective Screening of Depression and Anxiety](https://mlsanity.com/paper/2501.08769/) (2025)
- [LLMCARE: early detection of cognitive impairment via transformer models enhanced by LLM-generated synthetic data](https://mlsanity.com/paper/2508.10027/) (2025)
- [Context-aware attention layers coupled with optimal transport domain adaptation and multimodal fusion methods for recognizing dementia from spontaneous speech](https://mlsanity.com/paper/2305.16406/) (2023)

## Built on by (most cited first, 2 of 2)

- [The Voice of Equity: A Systematic Evaluation of Bias Mitigation Techniques for Speech-Based Cognitive Impairment Detection Across Architectures and Demographics](https://mlsanity.com/paper/2601.16989/) (2026)
- [Unifying Acoustic Features and Text with Multimodal LLMs for Neurodegenerative Screening](https://mlsanity.com/paper/2606.14788/) (2026)

## Abstract (arXiv)

Over half of US adults with Alzheimer disease and related dementias remain undiagnosed, and speech-based screening offers a scalable detection approach. We compared large language model adaptation strategies for dementia detection using the DementiaBank speech corpus, evaluating nine text-only models and three multimodal audio-text models on recordings from DementiaBank speech corpus. Adaptations included in-context learning with different demonstration selection policies, reasoning-augmented prompting, parameter-efficient fine-tuning, and multimodal integration. Results showed that class-centroid demonstrations achieved the highest in-context learning performance, reasoning improved smaller models, and token-level fine-tuning generally produced the best scores. Adding a classification head substantially improved underperforming models. Among multimodal models, fine-tuned audio-text systems performed well but did not surpass the top text-only models. These findings highlight that model adaptation strategies, including demonstration selection, reasoning design, and tuning method, critically influence speech-based dementia detection, and that properly adapted open-weight models can match or exceed commercial systems.