Potential Predictors for Cognitive Decline in Vascular Dementia: A Machine Learning Analysis

Vascular dementia (VD) is a cognitive impairment typical of advanced age with vascular etiology. It results from several vascular micro-accidents involving brain vessels carrying less oxygen and nutrients than it needs. This being a degenerative disease, the diagnosis often arrives too late, when the brain tissue is already damaged. Thus, prevention is the best solution to avoid irreversible cognitive impairment in patients with specific risk factors. Using the machine learning (ML) approach, our group evaluated Mini-Mental State Examination (MMSE) changes in patients affected by Alzheimer's disease by considering different clinical parameters. We decided to apply a similar ML scheme to VD due to the consistent data obtained from the first work, including the assessment of various ML models (LASSO, RIDGE, Elastic Net, CART, Random Forest) for the outcome prediction (i.e., the MMSE modification throughout time). MMSE at recruitment, folate, MCV, PTH, creatinine, vitamin B12, TSH, and hemoglobinwere the best predictive parameters individuated by the best ML model: Random Forest. ML results can be useful inidentify predictive biomarkers for cognitive worsening in VD early and also for focusing on necessary examinations at the first visits to draw the most predictive features, saving time and money and reducethe burden on the patients themselves. Such results should be integrated with brain imaging, physiological signal measurements, and sensory patterns, particularly forthose senses already demonstrated to have a significant link with neurodegeneration. Adjusting compound deficit by administering nutraceuticals could support treatment effectiveness and lead to a better quality of life for patients, families, and caregivers, with a consistent impact on the national health systems load.