Nearly 7 million Americans live with Alzheimer's disease (AD) today—with numbers expected to rise to nearly 14 million by 2060.

2023 Alzheimer’s disease facts and figures. Alzheimers Dement. 2023;19(4):1598-1695.

Before AD sets in, however, many people experience mild cognitive impairment (MCI)—which, in 3-15% of people, becomes AD every year.

Amini S, Hao B, Yang J, et al. Prediction of Alzheimer’s disease progression within 6 years using speech: A novel approach leveraging language models. Alzheimer’s; Dementia. 2024;20(8):5262-5270.

One way of potentially predicting AD? Analyzing speech patterns. According to new findings in Alzheimer’s & Dementia, published by the Journal of the Alzheimer’s Association,  speech patterns could indicate whether someone is at greater risk for developing Alzheimer's disease.

Amini S, Hao B, Yang J, et al. Prediction of Alzheimer’s disease progression within 6 years using speech: A novel approach leveraging language models. Alzheimer’s & Dementia. 2024;20(8):5262-5270.

To test this theory, the Boston University-based research team developed an artificial intelligence (AI) algorithm to analyze the speech patterns of patients. The machine was pre-programmed with voice recordings from over 1,000 individuals, enabling it to identify potential AD risks.

“Voice recordings from neuropsychological exams coupled with basic demographics can lead to strong predictive models of progression to dementia from mild cognitive impairment,” the researchers say. The algorithm now includes the voice recordings from the 166 participants.

Nield D. A signal of future alzheimer’s could be hidden in the way you speak. ScienceAlert.

What the experts think about this research

Sanam Hafeez, Psy.D, a neuropsychologist and director of Comprehend the Mind says the research helps to confirm the suspicion many experts have had all along—that certain patterns of speech are associated with AD: “Speech patterns, as well as behavioral changes, are seen alongside the more commonly known memory loss symptoms,” Dr. Hafeez says. “Further, cognitive testing…taxes the brain more than an informal conversation, which is why the speech patterns are more evident.”

Deepak S. Nair, MD, vice president of Neuroscience Service Line, shares another perspective: “In the setting of [MCI], every year, about 10-15% of patients will progress to a formal diagnosis of Alzheimer's dementia,” Dr. Nair says. “Over a lifetime, that conversion/progression rate is as high as 80%. Predicting this six-year conversion likelihood with improved accuracy will be an important aspect of patient management and counseling. Early recognition allows patients to discuss their goals of care and begin advanced care planning, which are both vital to effective care.”

Essentially, Dr. Nair thinks these findings are exciting: “This kind of work will revolutionise our approach to triage and early diagnosis/prediction of Alzheimer's…I can also see potential applications across various neurodegenerative disorders.”

In his own clinical practice, Dr. Nair has seen language impairments in patients with cognitive impairment, including reduced vocabulary, word-finding difficulty, and decreased fluency (overall speech output), like more pauses and filler sounds. “These can be very subtle, and easily missed by clinicians unfamiliar with the patient's normal baseline,” he says.

Dr. Hafeez also says she notices that patients with cognitive impairment or AD, “start to revert back to earlier language or dialects in those with multiple or bilingual backgrounds."

Not every healthcare practitioner is a fan of AI, though

Clifford Segil, DO, a neurologist at Providence Saint John’s Health Center in Santa Monica, CA, shares a totally different perspective: “I would never want a family member of mine diagnosed with a neurodegenerative disease from a machine—and this may be the way of the future,” Dr. Segil says. 

Nothing can replace a living, breathing expert, he says. “As a clinical neurologist I find it challenging to believe AI is going to take the place of neurologists and an in-person neurological exam from a neurologist to diagnose someone with something like AD,” Dr. Segil continues.

Others think AI hasn’t even begun to showcase the full scope of its AD-predicting power

James Jackson, Psy.D, director of Behavioral Health and professor of Medicine and Psychiatry at Vanderbilt University, says the research isn’t perfect. Still, its ideas—that speech is the “canary in the coal mine” are intriguing. 

Dr. Jackson says he’s seen speech issues in his clinical experience, as well: “I've had patients complain of changes in speech and language-related dynamics long before they develop dementia,” he says. “I think that is the experience of many other psychologists and neurologists, too. The good news here is that if we can, indeed, prove that an individual is on a likely path toward Alzheimer's disease well before it happens, this provides a critical window in which we can intervene.”

As for the use of AI, Dr. Jackson says there are reasons to be cautious, and that diagnosing dementia and AD is complex and clinically intensive. “I think we are barely on the cusp of realising what AI can do to help inform our work,” he says.