Cross-Dataset Evaluation of Dementia Longitudinal Progression Prediction Models

Accurately predicting Alzheimer's Disease (AD) progression is useful for clinical care. The 2019 TADPOLE (The Alzheimer's Disease Prediction Of Longitudinal Evolution) challenge evaluated 92 algorithms from 33 teams worldwide. Unlike typical clinical prediction studies, TADPOLE accommodates (1) a variable number of observed time points across patients, (2) missing data across modalities and visits, and (3) prediction over an open-ended time horizon, which better reflects real-world data. However, TADPOLE only used the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset, so how well top algorithms generalize to other cohorts remains unclear. We tested five algorithms in three external datasets covering 2312 participants and 13,200 time points. The algorithms included FROG, the overall TADPOLE winner, which utilized a unique Longitudinal-to-Cross-sectional (L2C) transformation to convert variable-length longitudinal histories into feature vectors of the same length across participants (i.e., same-length feature vectors). We also considered two FROG variants. One variant unified all XGBoost models from the original FROG with a single feedforward neural network (FNN), which we referred to as L2C-FNN. We also included minimal recurrent neural networks (MinimalRNN), which were ranked second at publication time, as well as AD Course Map (AD-Map), which outperformed MinimalRNN at publication time. All five models—three FROG variants, MinimalRNN, and AD-Map—were trained on ADNI and tested on the external datasets. L2C-FNN performed the best overall. In the case of predicting cognition and ventricle volume, L2C-FNN and AD-Map were the best. For clinical diagnosis prediction, L2C-FNN was the best, while AD-Map was the worst. L2C-FNN also maintained its edge over other models, regardless of the number of observed time points and regardless of the prediction horizon from 0 to 6 years into the future. L2C-FNN shows strong potential for both short-term and long-term dementia progression prediction. Pretrained ADNI models are available: https://github.com/ThomasYeoLab/CBIG/tree/master/stable_projects/predict_phenotypes/Zhang2025_L2CFNN.