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@ARTICLE{Lohner:280259,
author = {Lohner, Valerie and Badhwar, Amanpreet and Detcheverry,
Flavie E and García, Cindy L and Gellersen, Helena M and
Khodakarami, Zahra and Lattmann, Rene and Li, Rui and Low,
Audrey and Mazo, Claudia and Metz, Amelie and Parent,
Olivier and Phillips, Veronica and Saeed, Usman and Tan,
Sean Y W and Tamburin, Stefano and Llewellyn, David J and
Rittman, Timothy and Waters, Sheena and Bernal, Jose},
title = {{M}achine learning applications in vascular neuroimaging
for the diagnosis and prognosis of cognitive impairment and
dementia: a systematic review and meta-analysis.},
journal = {Alzheimer's research $\&$ therapy},
volume = {17},
number = {1},
issn = {1758-9193},
address = {London},
publisher = {BioMed Central},
reportid = {DZNE-2025-00937},
pages = {183},
year = {2025},
abstract = {Cerebral small vessel disease (CSVD) is a common
neurological condition that contributes to strokes,
dementia, disability, and mortality worldwide. We conducted
a systematic review and meta-analysis to investigate the use
of neuroimaging CSVD markers in machine learning (ML) based
diagnosis and prognosis of cognitive impairment and
dementia, and identify both methodological changes over time
and barriers to clinical translation.Following the PRISMA
guidelines, we systematically searched for original studies
that used both neuroimaging CSVD markers and ML methods for
diagnosing and prognosing neurodegenerative diseases
(preregistration in PROSPERO: CRD42022366767). Each paper
was independently reviewed by a pair of reviewers at all
stages, with a third consulted to resolve conflicts. We
meta-analysed the effectiveness of ML models to distinguish
healthy controls from Alzheimer’s dementia and cognitive
impairment, using area under the curve (AUC) as the
performance metric.We identified 75 studies: 43 on
diagnosis, 27 on prognosis, and 5 on both. Nearly $60\%$ of
studies were published in the past two years, reflecting a
growing interest in using CSVD markers in ML-based diagnosis
and prognosis of neurodegenerative diseases, especially
Alzheimer’s dementia. This rising interest may be linked
to the strong performance of such models: according to our
meta-analysis, ML approaches using CSVD markers perform well
in differentiating healthy controls from Alzheimer’s
dementia (AUC 0.88 $[95\%-CI$ 0.85–0.92]) and cognitive
impairment (AUC 0.84 $[95\%-CI$ 0.74–0.95]). However, the
growing interest has not been matched by methodological
rigour: only 16 studies met the criteria for inclusion in
the meta-analysis due to inconsistent reporting, only five
assessed the generalisability of their models on external
datasets, and six lacked clear diagnostic criteria.Interest
in incorporating CSVD markers into ML models for
neurodegenerative disease classification is on the rise, and
their performance suggests that this is worth further
exploration. Serious methodological issues, including
inconsistent reporting, limited generalisability testing,
and other potential biases, are unfortunately common and
hinder further adoption. Our targeted recommendations
provide a roadmap to accelerate the integration of ML into
clinical practice.The online version contains supplementary
material available at 10.1186/s13195-025-01815-6.},
keywords = {Alzheimer’s dementia (Other) / Artificial intelligence
(Other) / Cerebral small vessel disease (Other) / Cognitive
impairment (Other) / Dementia (Other) / Machine learning
(Other) / Neurodegenerative diseases (Other) / Neuroimaging
(Other)},
cin = {AG Berron / AG Düzel},
ddc = {610},
cid = {I:(DE-2719)5000070 / I:(DE-2719)5000006},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pmc = {pmc:PMC12330124},
pubmed = {pmid:40775365},
doi = {10.1186/s13195-025-01815-6},
url = {https://pub.dzne.de/record/280259},
}