MMSE-Calibrated Few-Shot Prompting for Alzheimer's Detection

Prompting large language models is a training-free method for detecting Alzheimer's disease from speech transcripts. Using the ADReSS dataset, we revisit zero-shot prompting and study few-shot prompting with a class-balanced protocol using nested interleave and a strict schema, sweeping up to 20 examples per class. We evaluate two variants achieving state-of-the-art prompting results. (i) MMSE-Proxy Prompting: each few-shot example carries a probability anchored to Mini-Mental State Examination bands via a deterministic mapping, enabling AUC computing; this reaches 0.82 accuracy and 0.86 AUC (ii) Reasoning-augmented Prompting: few-shot examples pool is generated with a multimodal LLM (GPT-5) that takes as input the Cookie Theft image, transcript, and MMSE to output a reasoning and MMSE-aligned probability; evaluation remains transcript-only and reaches 0.82 accuracy and 0.83 AUC. To our knowledge, this is the first ADReSS study to anchor elicited probabilities to MMSE and to use multimodal construction to improve interpretability.