Interpretable self-supervised transformers for resting-state EEG analysis in Alzheimer's disease.

Existing EEG-based methods have been constrained by limited availability of labeled data, hand-crafted features, poor spatio-temporal modeling, sub-optimal cross-hardware performance, and lack of interpretability due to being expensive and intrusive. To address these limitations, this study introduces innovative neural signal decoding techniques for cognitive state modeling in order to enhance the potential of AI-integrated models for early detection of Alzheimer's disease. This research introduces a self-supervised spatio-temporal transformer (STT-EEG) for early detection of Alzheimer's disease from resting-state EEG. This framework includes four key components: first, self-supervised pretraining on 111 healthy controls using masked auto-encoding and temporal order prediction to learn robust generalisable representations. Second, a novel spatial attention module (SAM) that explicitly captures both long-range temporal dependencies and channel interactions, reflecting the distributed network pathology of AD; third, cross-dataset transfer learning from 64-channel BioSemi to 19-channel Nihon Kohden systems, which showed strong hardware generalization; and finally, analyses of attention rollout and channel perturbation for clinically interpretable insights. The model was trained in a subject-wise 5-fold cross-validation fashion on the SRM dataset and fine-tuned on the OpenNeuro dataset (ds004504) consisting of 36 AD and 29 CN. On the same dataset, the accuracy of STT-EEG was 96.42% for AD vs. CN classification. The most significant improvement +7.08% was made with the help of self-supervised pretraining, followed by data augmentation +6.30% and the SAM +4.86%, as was confirmed in the ablation studies. For continuous prediction of MMSE scores, the Pearson correlation of the model was 0.872 and the mean absolute error (MAE) was 2.34 points. Regions of T3-T6, P3-Pz-P4 and O1-O2 were identified as areas of attention-based interpretability, which were consistent with the known neuropathology of AD that involved the temporoparietal lobe. STT-EEG strengths include the high interpretability of the framework, its spatio-temporal attention, and the fact that STT-EEG is a self-supervised learning method and can be used in an efficient and generalizable way.