# PROMISE-AD: Progression-aware Multi-horizon Survival Estimation for Alzheimer's Disease Progression and Dynamic Tracking

arXiv: https://arxiv.org/abs/2604.28055 · HTML: https://mlsanity.com/paper/2604.28055/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 0 of its 37 references that are in the map.
- First posted on arXiv 30 Apr 2026.

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

- [Calibrated Alzheimer's Conversion Risk in Mild Cognitive Impairment: Persistent Homology of Clinical Trajectories with Conformal Guarantees](https://mlsanity.com/paper/2607.17442/) (2026)

## Abstract (arXiv)

Individualized Alzheimer's disease (AD) progression prediction requires models that use irregular visits, account for censoring, avoid diagnostic leakage, and provide calibrated horizon risks. We propose PROgression-aware MultI-horizon Survival Estimation for Alzheimer's Disease (PROMISE-AD), a leakage-safe survival framework for predicting conversion from cognitively normal (CN) to mild cognitive impairment (MCI) and from MCI to AD dementia using ADNI/TADPOLE tabular histories. PROMISE-AD converts pre-index visits into tokens with standardized measurements, missingness masks, longitudinal changes, time-normalized slopes, visit timing, and non-diagnostic categorical attributes. A temporal Transformer fuses global, attention-pooled, and latest-visit representations to estimate a progression score and latent discrete-time mixture hazards. Training combines survival likelihood, horizon-specific focal risk loss, progression ranking, hazard smoothness, and mixture-balance regularization, followed by validation-set isotonic calibration for 1-, 2-, 3-, and 5-year risks. In held-out testing across three seeds, PROMISE-AD achieved an integrated Brier score (IBS) of 0.085 ± 0.012, C-index of 0.808 ± 0.015, and mean time-dependent AUC of 0.840 ± 0.081 for CN-to-MCI conversion, yielding the lowest IBS among compared methods. For MCI-to-AD conversion, PROMISE-AD achieved the highest C-index (0.894 ± 0.018) and near-ceiling 5-year discrimination (AUROC 0.997 ± 0.003; AUPRC 0.999 ± 0.001), although some baselines had lower IBS. Ablations and interpretability supported longitudinal change features, fused temporal representations, mixture hazards, cognitive and functional measures, APOE4 status, and recent conversion-proximal visits. These findings suggest that progression-aware survival modeling can provide interpretable multi-horizon AD conversion risk estimates.