# EMAD: Evidence-Centric Grounded Multimodal Diagnosis for Alzheimer's Disease

arXiv: https://arxiv.org/abs/2602.19178 · HTML: https://mlsanity.com/paper/2602.19178/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 28 of its 49 references that are in the map.
- First posted on arXiv 22 Feb 2026.

## Builds on (most cited first, 28 of 28)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [RoBERTa: A Robustly Optimized BERT Pretraining Approach](https://mlsanity.com/paper/1907.11692/) (2019)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [Longformer: The Long-Document Transformer](https://mlsanity.com/paper/2004.05150/) (2020)
- [DeBERTaV3: Improving DeBERTa using ELECTRA-Style Pre-Training with Gradient-Disentangled Embedding Sharing](https://mlsanity.com/paper/2111.09543/) (2021)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [A Survey of Reinforcement Learning for Large Reasoning Models](https://mlsanity.com/paper/2509.08827/) (2025)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [M3D: Advancing 3D Medical Image Analysis with Multi-Modal Large Language Models](https://mlsanity.com/paper/2404.00578/) (2024)
- [Large Language Models(LLMs) on Tabular Data: Prediction, Generation, and Understanding -- A Survey](https://mlsanity.com/paper/2402.17944/) (2024)
- [MedKLIP: Medical Knowledge Enhanced Language-Image Pre-Training in Radiology](https://mlsanity.com/paper/2301.02228/) (2023)
- [Improving Factual Completeness and Consistency of Image-to-Text Radiology Report Generation](https://mlsanity.com/paper/2010.10042/) (2020)
- [Automated brain extraction of multi-sequence MRI using artificial neural networks](https://mlsanity.com/paper/1901.11341/) (2019)
- [SeqFormer: Sequential Transformer for Video Instance Segmentation](https://mlsanity.com/paper/2112.08275/) (2021)
- [MedBLIP: Bootstrapping Language-Image Pre-training from 3D Medical Images and Texts](https://mlsanity.com/paper/2305.10799/) (2023)
- [The Ethics of ChatGPT in Medicine and Healthcare: A Systematic Review on Large Language Models (LLMs)](https://mlsanity.com/paper/2403.14473/) (2024)
- [A Transformer-based representation-learning model with unified processing of multimodal input for clinical diagnostics](https://mlsanity.com/paper/2306.00864/) (2023)
- [Deep reinforcement learning in medical imaging: A literature review](https://mlsanity.com/paper/2103.05115/) (2021)
- [Optimizing Safe and Aligned Language Generation: A Multi-Objective GRPO Approach](https://mlsanity.com/paper/2503.21819/) (2025)
- [RadAlign: Advancing Radiology Report Generation with Vision-Language Concept Alignment](https://mlsanity.com/paper/2501.07525/) (2025)
- [Enhancing Large Language Model Reasoning with Reward Models: An Analytical Survey](https://mlsanity.com/paper/2510.01925/) (2025)
- [AliFuse: Aligning and Fusing Multi-modal Medical Data for Computer-Aided Diagnosis](https://mlsanity.com/paper/2401.01074/) (2024)
- [HoloDx: Knowledge- and Data-Driven Multimodal Diagnosis of Alzheimer's Disease](https://mlsanity.com/paper/2504.19075/) (2025)

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

- [Cerebra: A Multidisciplinary AI Board for Multimodal Dementia Characterization and Risk Assessment](https://mlsanity.com/paper/2603.21597/) (2026)

## Abstract (arXiv)

Deep learning models for medical image analysis often act as black boxes, seldom aligning with clinical guidelines or explicitly linking decisions to supporting evidence. This is especially critical in Alzheimer's disease (AD), where predictions should be grounded in both anatomical and clinical findings. We present EMAD, a vision-language framework that generates structured AD diagnostic reports in which each claim is explicitly grounded in multimodal evidence. EMAD uses a hierarchical Sentence-Evidence-Anatomy (SEA) grounding mechanism: (i) sentence-to-evidence grounding links generated sentences to clinical evidence phrases, and (ii) evidence-to-anatomy grounding localizes corresponding structures on 3D brain MRI. To reduce dense annotation requirements, we propose GTX-Distill, which transfers grounding behavior from a teacher trained with limited supervision to a student operating on model-generated reports. We further introduce Executable-Rule GRPO, a reinforcement fine-tuning scheme with verifiable rewards that enforces clinical consistency, protocol adherence, and reasoning-diagnosis coherence. On the AD-MultiSense dataset, EMAD achieves state-of-the-art diagnostic accuracy and produces more transparent, anatomically faithful reports than existing methods. We will release code and grounding annotations to support future research in trustworthy medical vision-language models.