Toward attention-based learning to predict the risk of brain degeneration with multimodal medical data.

Introduction: Brain degeneration is commonly caused by some chronic diseases, such as Alzheimer's disease (AD) and diabetes mellitus (DM). The risk prediction of brain degeneration aims to forecast the situation of disease progression of patients in the near future based on their historical health records. It is beneficial for patients to make an accurate clinical diagnosis and early prevention of disease. Current risk predictions of brain degeneration mainly rely on single-modality medical data, such as Electronic Health Records (EHR) or magnetic resonance imaging (MRI). However, only leveraging EHR or MRI data for the pertinent and accurate prediction is insufficient because of single-modality information (e.g., pixel or volume information of image data or clinical context information of non-image data). Methods: Several deep learning-based methods have used multimodal data to predict the risks of specified diseases. However, most of them simply integrate different modalities in an early, intermediate, or late fusion structure and do not care about the intra-modal and intermodal dependencies. A lack of these dependencies would lead to sub-optimal prediction performance. Thus, we propose an encoder-decoder framework for better risk prediction of brain degeneration by using MRI and EHR. An encoder module is one of the key components and mainly focuses on feature extraction of input data. Specifically, we introduce an encoder module, which integrates intra-modal and inter-modal dependencies with the spatial-temporal attention and cross-attention mechanism. The corresponding decoder module is another key component and mainly parses the features from the encoder. In the decoder module, a disease-oriented module is used to extract the most relevant disease representation features. We take advantage of a multi-head attention module followed by a fully connected layer to produce the predicted results. Results: As different types of AD and DM influence the nature and severity of brain degeneration, we evaluate the proposed method for three-class prediction of AD and three-class prediction of DM. Our results show that the proposed method with integrated MRI and EHR data achieves an accuracy of 0.859 and 0.899 for the risk prediction of AD and DM, respectively. Discussion: The prediction performance is significantly better than the benchmarks, including MRI-only, EHR-only, and state-of-the-art multimodal fusion methods.