Estimation of the epidemiology of dementia and associated neuropsychiatric symptoms by applying machine learning to real-world data.

INTRODUCTION: Incidence rates of dementia-related neuropsychiatric symptoms (NPS) are not known and this hampers the assessment of their population burden. The objective of this study was to obtain an approximate estimate of the population incidence and prevalence of both dementia and NPS. METHODS: Given the dynamic nature of the population with dementia, a retrospective study was conducted within the database of the Basque Health Service (real-world data) at the beginning and end of 2019. Validated random forest models were used to identify separately depressive and psychotic clusters according to their presence in the electronic health records of all patients diagnosed with dementia. RESULTS: Among the 631,949 individuals over 60 years registered, 28,563 were diagnosed with dementia, of whom 15,828 (55.4%) showed psychotic symptoms and 19,461 (68.1%) depressive symptoms. The incidence of dementia in 2019 was 6.8/1000 person-years. Most incident cases of depressive (72.3%) and psychotic (51.9%) NPS occurred in cases of incident dementia. The risk of depressive-type NPS grows with years since dementia diagnosis, living in a nursing home, and female sex, but falls with older age. In the psychotic cluster model, the effects of male sex, and older age are inverted, both increasing the probability of this type of symptoms. CONCLUSIONS: The stigmatization factor conditions the social and attitudinal environment, delaying the diagnosis of dementia, preventing patients from receiving adequate care and exacerbating families' suffering. This study evidences the synergy between big data and real-world data for psychiatric epidemiological research.

Estimation of the epidemiology of dementia and associated neuropsychiatric symptoms by applying machine learning to real-world data

Introduction: Incidence rates of dementia-related neuropsychiatric symptoms (NPS) are not known and this hampers the assessment of their population burden. The objective of this study was to obtain an approximate estimate of the population incidence and prevalence of both dementia and NPS.Methods: Given the dynamic nature of the population with dementia, a retrospective study was conducted within the database of the Basque Health Service (real-world data) at the beginning and end of 2019. Validated random forest models were used to identify separately depressive and psychotic clusters according to their presence in the electronic health records of all patients diagnosed with dementia.Results: Among the 631,949 individuals over 60 years registered, 28,563 were diagnosed with dementia, of whom 15,828 (55.4%) showed psychotic symptoms and 19,461 (68.1%) depressive symptoms. The incidence of dementia in 2019 was 6.8/1000 person-years. Most incident cases of depressive (72.3%) and psychotic (51.9%) NPS occurred in cases of incident dementia. The risk of depressive-type NPS grows with years since dementia diagnosis, living in a nursing home, and female sex, but falls with older age. In the psychotic cluster model, the effects of male sex, and older age are inverted, both increasing the probability of this type of symptoms.Conclusions: The stigmatization factor conditions the social and attitudinal environment, delaying the diagnosis of dementia, preventing patients from receiving adequate care and exacerbating families’ suffering. This study evidences the synergy between big data and real-world data for psychiatric epidemiological research. (AU)

Introducción: Se desconocen las tasas de incidencia de los síntomas neuropsiquiátricos (SN) asociados a la demencia, lo cual dificulta la evaluación de su carga para la población. El objetivo de este estudio fue obtener una estimación aproximada de la incidencia y prevalencia en la población tanto de la demencia como de los SN.Métodos: Dada la naturaleza dinámica de la población con demencia, se realizó un estudio dentro de la base de datos del Servicio Vasco de Salud (datos del mundo real) a comienzos y finales de 2019. Se utilizaron modelos de bosques aleatorios validados para identificar por separado los clústeres depresivos y psicóticos, con arreglo a su presencia en los registros sanitarios electrónicos de todos los pacientes con diagnóstico de demencia.Resultados: Entre los 631.949 individuos mayores de 60 años registrados, 28.563 fueron diagnosticados de demencia, de los cuales 15.828 (55,4%) mostraron síntomas psicóticos y 19.461 (68,1%) síntomas depresivos. La incidencia de la demencia en 2019 fue de 6,8/1.000 personas-años. Muchos de los casos incidentes de SN depresivos (72,3%) y psicóticos (51,9%) se produjeron en casos de demencia incidente. El riesgo de SN de tipo depresivo se incrementa con factores tales como los años transcurridos desde que se diagnostica la demencia, la residencia en un sanatorio, y el sexo femenino, pero desciende con la edad avanzada. En el modelo de clúster psicótico, los efectos del sexo masculino y la edad avanzada se invierten, incrementando ambos la probabilidad de este tipo de síntomas.Conclusiones: El factor de estigmatización condiciona el entorno social y actitudinal, demorando el diagnóstico de la demencia, impidiendo que los pacientes reciban los cuidados adecuados, y exacerbando el sufrimiento de las familias. Este estudio evidencia la sinergia entre los grandes datos y los datos del mundo real para la investigación epidemiológica psiquiátrica. (AU)

Estimation of the epidemiology of dementia and associated neuropsychiatric symptoms by applying machine learning to real-world data.

INTRODUCTION: Incidence rates of dementia-related neuropsychiatric symptoms (NPS) are not known and this hampers the assessment of their population burden. The objective of this study was to obtain an approximate estimate of the population incidence and prevalence of both dementia and NPS. METHODS: Given the dynamic nature of the population with dementia, a retrospective study was conducted within the database of the Basque Health Service (real-world data) at the beginning and end of 2019. Validated random forest models were used to identify separately depressive and psychotic clusters according to their presence in the electronic health records of all patients diagnosed with dementia. RESULTS: Among the 631,949 individuals over 60 years registered, 28,563 were diagnosed with dementia, of whom 15,828 (55.4%) showed psychotic symptoms and 19,461 (68.1%) depressive symptoms. The incidence of dementia in 2019 was 6.8/1000 person-years. Most incident cases of depressive (72.3%) and psychotic (51.9%) NPS occurred in cases of incident dementia. The risk of depressive-type NPS grows with years since dementia diagnosis, living in a nursing home, and female sex, but falls with older age. In the psychotic cluster model, the effects of male sex, and older age are inverted, both increasing the probability of this type of symptoms. CONCLUSIONS: The stigmatization factor conditions the social and attitudinal environment, delaying the diagnosis of dementia, preventing patients from receiving adequate care and exacerbating families' suffering. This study evidences the synergy between big data and real-world data for psychiatric epidemiological research.

Validation of Random Forest Machine Learning Models to Predict Dementia-Related Neuropsychiatric Symptoms in Real-World Data.

BACKGROUND: Neuropsychiatric symptoms (NPS) are the leading cause of the social burden of dementia but their role is underestimated. OBJECTIVE: The objective of the study was to validate predictive models to separately identify psychotic and depressive symptoms in patients diagnosed with dementia using clinical databases representing the whole population to inform decision-makers. METHODS: First, we searched the electronic health records of 4,003 patients with dementia to identify NPS. Second, machine learning (random forest) algorithms were applied to build separate predictive models for psychotic and depressive symptom clusters in the training set (N = 3,003). Third, calibration and discrimination were assessed in the test set (N = 1,000) to assess the performance of the models. RESULTS: Neuropsychiatric symptoms were noted in the electronic health record of 58% of patients. The area under the receiver operating curve reached 0.80 for the psychotic cluster model and 0.74 for the depressive cluster model. The Kappa index and accuracy also showed better discrimination in the psychotic model. Calibration plots indicated that both types of model had less predictive accuracy when the probability of neuropsychiatric symptoms was <25%. The most important variables in the psychotic cluster model were use of risperidone, level of sedation, use of quetiapine and haloperidol and the number of antipsychotics prescribed. In the depressive cluster model, the most important variables were number of antidepressants prescribed, escitalopram use, level of sedation, and age. CONCLUSION: Given their relatively good performance, the predictive models can be used to estimate prevalence of NPS in population databases.

Calibration model maintenance in melamine resin production: Integrating drift detection, smart sample selection and model adaptation.

The physico-chemical properties of Melamine Formaldehyde (MF) based thermosets are largely influenced by the degree of polymerization (DP) in the underlying resin. On-line supervision of the turbidity point by means of vibrational spectroscopy has recently emerged as a promising technique to monitor the DP of MF resins. However, spectroscopic determination of the DP relies on chemometric models, which are usually sensitive to drifts caused by instrumental and/or sample-associated changes occurring over time. In order to detect the time point when drifts start causing prediction bias, we here explore a universal drift detector based on a faded version of the Page-Hinkley (PH) statistic, which we test in three data streams from an industrial MF resin production process. We employ committee disagreement (CD), computed as the variance of model predictions from an ensemble of partial least squares (PLS) models, as a measure for sample-wise prediction uncertainty and use the PH statistic to detect changes in this quantity. We further explore supervised and unsupervised strategies for (semi-)automatic model adaptation upon detection of a drift. For the former, manual reference measurements are requested whenever statistical thresholds on Hotelling's T2 and/or Q-Residuals are violated. Models are subsequently re-calibrated using weighted partial least squares in order to increase the influence of newer samples, which increases the flexibility when adapting to new (drifted) states. Unsupervised model adaptation is carried out exploiting the dual antecedent-consequent structure of a recently developed fuzzy systems variant of PLS termed FLEXFIS-PLS. In particular, antecedent parts are updated while maintaining the internal structure of the local linear predictors (i.e. the consequents). We found improved drift detection capability of the CD compared to Hotelling's T2 and Q-Residuals when used in combination with the proposed PH test. Furthermore, we found that active selection of samples by active learning (AL) used for subsequent model adaptation is advantageous compared to passive (random) selection in case that a drift leads to persistent prediction bias allowing more rapid adaptation at lower reference measurement rates. Fully unsupervised adaptation using FLEXFIS-PLS could improve predictive accuracy significantly for light drifts but was not able to fully compensate for prediction bias in case of significant lack of fit w.r.t. the latent variable space.

Improved quantification of important beer quality parameters based on nonlinear calibration methods applied to FT-MIR spectra.

During the production process of beer, it is of utmost importance to guarantee a high consistency of the beer quality. For instance, the bitterness is an essential quality parameter which has to be controlled within the specifications at the beginning of the production process in the unfermented beer (wort) as well as in final products such as beer and beer mix beverages. Nowadays, analytical techniques for quality control in beer production are mainly based on manual supervision, i.e., samples are taken from the process and analyzed in the laboratory. This typically requires significant lab technicians efforts for only a small fraction of samples to be analyzed, which leads to significant costs for beer breweries and companies. Fourier transform mid-infrared (FT-MIR) spectroscopy was used in combination with nonlinear multivariate calibration techniques to overcome (i) the time consuming off-line analyses in beer production and (ii) already known limitations of standard linear chemometric methods, like partial least squares (PLS), for important quality parameters Speers et al. (J I Brewing. 2003;109(3):229-235), Zhang et al. (J I Brewing. 2012;118(4):361-367) such as bitterness, citric acid, total acids, free amino nitrogen, final attenuation, or foam stability. The calibration models are established with enhanced nonlinear techniques based (i) on a new piece-wise linear version of PLS by employing fuzzy rules for local partitioning the latent variable space and (ii) on extensions of support vector regression variants (𝜖-PLSSVR and ν-PLSSVR), for overcoming high computation times in high-dimensional problems and time-intensive and inappropriate settings of the kernel parameters. Furthermore, we introduce a new model selection scheme based on bagged ensembles in order to improve robustness and thus predictive quality of the final models. The approaches are tested on real-world calibration data sets for wort and beer mix beverages, and successfully compared to linear methods, showing a clear out-performance in most cases and being able to meet the model quality requirements defined by the experts at the beer company. Figure Workflow for calibration of non-Linear model ensembles from FT-MIR spectra in beer production .

Evolving chemometric models for predicting dynamic process parameters in viscose production.

In viscose production, it is important to monitor three process parameters in order to assure a high quality of the final product: the concentrations of H(2)SO(4), Na(2)SO(4) and Z(n)SO(4). During on-line production these process parameters usually show a quite high dynamics depending on the fiber type that is produced. Thus, conventional chemometric models, which are trained based on collected calibration spectra from Fourier transform near infrared (FT-NIR) measurements and kept fixed during the whole life-time of the on-line process, show a quite imprecise and unreliable behavior when predicting the concentrations of new on-line data. In this paper, we are demonstrating evolving chemometric models which are able to adapt automatically to varying process dynamics by updating their inner structures and parameters in a single-pass incremental manner. These models exploit the Takagi-Sugeno fuzzy model architecture, being able to model flexibly different degrees of non-linearities implicitly contained in the mapping between near infrared spectra (NIR) and reference values. Updating the inner structures is achieved by moving the position of already existing local regions and by evolving (increasing non-linearity) or merging (decreasing non-linearity) new local linear predictors on demand, which are guided by distance-based and similarity criteria. Gradual forgetting mechanisms may be integrated in order to out-date older learned relations and to account for more flexibility of the models. The results show that our approach is able to overcome the huge prediction errors produced by various state-of-the-art chemometric models. It achieves a high correlation between observed and predicted target values in the range of [0.95,0.98] over a 3 months period while keeping the relative error below the reference error value of 3%. In contrast, the off-line techniques achieved correlations below 0.5, ten times higher error rates and the more deteriorate, the more time passes by.

Identificación y valoración neuropsicológica del riesgo perinatal: instrumentos / Instruments for identifying perinatal risk and associated neuropsychological evaluation

Algunas complicaciones maternas perinatales específicas pueden ser determinantes en el desarrollo infantil. Se constata que muchos niños con una amplia variedad de alteraciones han sufrido diversas complicaciones durante su desarrollo gestacional. Por lo tanto, los riesgos maternos ocurridos a lo largo del período pre-perinatal llevan asociados, en ocasiones, diferentes daños, sean neuropsicológicos, físicos y/o psicosociales. En el presente artículo se identifican los principales factores asociados al riesgo perinatal y sus implicaciones, haciendo un recorrido por los procedimientos estandarizados de evaluación del riesgo, desde la perspectiva médico neuropsicológica y psicosocial del neonato.