{"ID":2878913,"CreatedAt":"2026-06-01T04:54:23.091178241Z","UpdatedAt":"2026-06-01T04:54:23.091178241Z","DeletedAt":null,"paper_url":"https://arxiv.org/abs/2509.03525","arxiv_id":"2509.03525","title":"Speech-Based Cognitive Screening: A Systematic Evaluation of LLM Adaptation Strategies","abstract":"Over half of US adults with Alzheimer disease and related dementias remain undiagnosed, and speech-based screening offers a scalable detection approach. We compared large language model adaptation strategies for dementia detection using the DementiaBank speech corpus, evaluating nine text-only models and three multimodal audio-text models on recordings from DementiaBank speech corpus. Adaptations included in-context learning with different demonstration selection policies, reasoning-augmented prompting, parameter-efficient fine-tuning, and multimodal integration. Results showed that class-centroid demonstrations achieved the highest in-context learning performance, reasoning improved smaller models, and token-level fine-tuning generally produced the best scores. Adding a classification head substantially improved underperforming models. Among multimodal models, fine-tuned audio-text systems performed well but did not surpass the top text-only models. These findings highlight that model adaptation strategies, including demonstration selection, reasoning design, and tuning method, critically influence speech-based dementia detection, and that properly adapted open-weight models can match or exceed commercial systems.","short_abstract":"Over half of US adults with Alzheimer disease and related dementias remain undiagnosed, and speech-based screening offers a scalable detection approach. We compared large language model adaptation strategies for dementia detection using the DementiaBank speech corpus, evaluating nine text-only models and three multimod...","url_abs":"https://arxiv.org/abs/2509.03525","url_pdf":"https://arxiv.org/pdf/2509.03525v2","authors":"[\"Fatemeh Taherinezhad\",\"Mohamad Javad Momeni Nezhad\",\"Sepehr Karimi\",\"Sina Rashidi\",\"Ali Zolnour\",\"Maryam Dadkhah\",\"Yasaman Haghbin\",\"Hossein AzadMaleki\",\"Maryam Zolnoori\"]","published":"2025-08-24T13:15:28Z","proceeding":"cs.CL","tasks":"[\"cs.CL\",\"cs.AI\",\"eess.AS\"]","methods":"[\"Large Language Model\",\"Language Model\"]","has_code":false}