# National Institute on Aging PREPARE Challenge: Early Detection of Cognitive Impairment Using Speech -- The SpeechCARE Solution

arXiv: https://arxiv.org/abs/2511.08132 · HTML: https://mlsanity.com/paper/2511.08132/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Medical and biomedical MoE, one of 12 directions in Mixture-of-experts.
- Builds on 21 of its 72 references that are in the map.
- First posted on arXiv 11 Nov 2025.

## Placed in

- Mixture-of-experts / [Medical and biomedical MoE](https://mlsanity.com/moe/medical-and-biomedical-moe/)

## Builds on (most cited first, 21 of 21)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [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)
- [Robust Speech Recognition via Large-Scale Weak Supervision](https://mlsanity.com/paper/2212.04356/) (2022)
- [Unsupervised Cross-lingual Representation Learning at Scale](https://mlsanity.com/paper/1911.02116/) (2019)
- [wav2vec 2.0: A Framework for Self-Supervised Learning of Speech Representations](https://mlsanity.com/paper/2006.11477/) (2020)
- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [A Survey of Large Language Models](https://mlsanity.com/paper/2303.18223/) (2023)
- [HuBERT: Self-Supervised Speech Representation Learning by Masked Prediction of Hidden Units](https://mlsanity.com/paper/2106.07447/) (2021)
- [Equality of Opportunity in Supervised Learning](https://mlsanity.com/paper/1610.02413/) (2016)
- [SpecAugment: A Simple Data Augmentation Method for Automatic Speech Recognition](https://mlsanity.com/paper/1904.08779/) (2019)
- [M3-Embedding: Multi-Linguality, Multi-Functionality, Multi-Granularity Text Embeddings Through Self-Knowledge Distillation](https://mlsanity.com/paper/2402.03216/) (2024)
- [CNN Architectures for Large-Scale Audio Classification](https://mlsanity.com/paper/1609.09430/) (2016)
- [Mitigating Unwanted Biases with Adversarial Learning](https://mlsanity.com/paper/1801.07593/) (2018)
- [AST: Audio Spectrogram Transformer](https://mlsanity.com/paper/2104.01778/) (2021)
- [XLS-R: Self-supervised Cross-lingual Speech Representation Learning at Scale](https://mlsanity.com/paper/2111.09296/) (2021)
- [mGTE: Generalized Long-Context Text Representation and Reranking Models for Multilingual Text Retrieval](https://mlsanity.com/paper/2407.19669/) (2024)
- [mHuBERT-147: A Compact Multilingual HuBERT Model](https://mlsanity.com/paper/2406.06371/) (2024)
- [Multimodal Multi-loss Fusion Network for Sentiment Analysis](https://mlsanity.com/paper/2308.00264/) (2023)
- [LLMCARE: early detection of cognitive impairment via transformer models enhanced by LLM-generated synthetic data](https://mlsanity.com/paper/2508.10027/) (2025)
- [Performance Assessment of ChatGPT vs Bard in Detecting Alzheimer's Dementia](https://mlsanity.com/paper/2402.01751/) (2024)

## Built on by (most cited first, 1 of 1)

- [From Black-Box to Clinical Insight: A Multi-Stage Explainable Framework for Speech-Based Cognitive Impairment Detection](https://mlsanity.com/paper/2606.27973/) (2026)

## Abstract (arXiv)

Alzheimer's disease and related dementias (ADRD) affect one in five adults over 60, yet more than half of individuals with cognitive decline remain undiagnosed. Speech-based assessments show promise for early detection, as phonetic motor planning deficits alter acoustic features (e.g., pitch, tone), while memory and language impairments lead to syntactic and semantic errors. However, conventional speech-processing pipelines with hand-crafted features or general-purpose audio classifiers often exhibit limited performance and generalizability. To address these limitations, we introduce SpeechCARE, a multimodal speech processing pipeline that leverages pretrained, multilingual acoustic and linguistic transformer models to capture subtle speech-related cues associated with cognitive impairment. Inspired by the Mixture of Experts (MoE) paradigm, SpeechCARE employs a dynamic fusion architecture that weights transformer-based acoustic, linguistic, and demographic inputs, allowing integration of additional modalities (e.g., social factors, imaging) and enhancing robustness across diverse tasks. Its robust preprocessing includes automatic transcription, large language model (LLM)-based anomaly detection, and task identification. A SHAP-based explainability module and LLM reasoning highlight each modality's contribution to decision-making. SpeechCARE achieved AUC = 0.88 and F1 = 0.72 for classifying cognitively healthy, MCI, and AD individuals, with AUC = 0.90 and F1 = 0.62 for MCI detection. Bias analysis showed minimal disparities, except for adults over 80. Mitigation techniques included oversampling and weighted loss. Future work includes deployment in real-world care settings (e.g., VNS Health, Columbia ADRC) and EHR-integrated explainability for underrepresented populations in New York City.