medRxiv (Medicine)
2026-06-24
DOI: HASH:5864d8464b4a9aa838ee639e86eaed0f
ABSTRACT Dementia classification in heterogeneous populations is complicated by the influence of education, language, socioeconomic position and health status on cognitive test performance. Approaches that rely on fixed cognitive thresholds or isolated predictor sets may therefore perform inconsistently across diverse older adult populations. We developed and internally validated a multidomain classification model using harmonized data from the Longitudinal Ageing Study in India (LASI) and its diagnostic sub-study, LASI-DAD. Clinical dementia status was defined as a binary outcome derived from consensus-based Clinical Dementia Rating (CDR) assessments, averaged across 20 multiply imputed outcome datasets and finalised using a 0.5 threshold. The analytic sample comprised 3,186 participants after exclusion of those with mild cognitive impairment. Twenty-two predictors spanning cognitive performance, informant-reported decline, cardiometabolic biomarkers and sociodemographic characteristics were retained. Missing predictor values were addressed using k-nearest neighbours imputation. Model development used a stratified 70:30 train-test split, with nested cross-validation conducted within the training set only, and class imbalance corrected using the Synthetic Minority Oversampling Technique (SMOTE) applied exclusively within training folds. Five supervised learning approaches were evaluated: logistic regression, random forest, gradient boosting, XGBoost and support vector machines. The final logistic regression model achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.932 and an average precision of 0.668 on the held-out set. At the optimal probability threshold of 0.70, sensitivity was 0.771, specificity was 0.905, positive predictive value was 0.325 and negative predictive value was 0.985. A cognition-only comparator, restricted to task-based cognitive measures and run through the same pipeline, yielded a ROC-AUC of 0.908 and average precision of 0.620, indicating incremental discriminatory value from the full multidomain feature set. Dementia prevalence increased progressively across model-derived risk strata, reaching approximately 50% in the highest category. Permutation importance and SHAP analyses identified informant-reported decline and orientation as the strongest contributors to classification, with cardiometabolic variables providing smaller but consistent incremental contributions. Dementia classification in a socially and clinically heterogeneous Indian cohort can be improved by integrating cognitive, informant, cardiometabolic and sociodemographic information within a single interpretable model. The strongest predictive signal was carried by cognitive and informant measures, with non-cognitive features adding structure around that core. The model requires external validation and calibration before broader application can be considered. Keywords - dementia; classification; multidomain modelling; machine learning; interpretability; older adults; India; LASI-DAD