Linear mixed-effect models provide a natural baseline for estimating disease progression using longitudinal data. They provide interpretable models at the cost of modeling assumptions on the progression profiles and their variability across subjects. A significant improvement is to embed the data in a Riemannian manifold and learn patient-specific trajectories distributed around a central geodesic. A few interpretable parameters characterize subject trajectories at the cost of a prior choice of the metric, which determines the shape of the trajectories. We extend this approach by learning the metric from the data allowing more flexibility while keeping the interpretability. Specifically, we learn the metric as the push-forward of the Euclidean metric by a diffeomorphism. This diffeomorphism is estimated iteratively as the composition of radial basis functions belonging to a reproducible kernel Hilbert space. The metric update allows us to improve the forecasting of imaging and clinical biomarkers in the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. Our results compare favorably to the 56 methods benchmarked in the TADPOLE challenge.

A practical solution to these problems has been using hidden Markov models (HMMs), which (i) can A particular challenge for disease progression be trained using small datasets, (ii) can handle missing data modeling is the heterogeneity of a disease and in a principled approach and (iii) are interpretable models, its manifestations in the patients. Existing approaches e.g., it is possible to relate inferred latent states to particular often assume the presence of a single symptoms. Most existing HMMs (Jackson et al., 2003; disease progression characteristics which is unlikely Sukkar et al., 2012; Guihenneuc-Jouyaux et al., 2000; Wang for neurodegenerative disorders such as et al., 2014; Sun et al., 2019; Severson et al., 2020; 2021), Parkinson' disease. In this paper, we propose however, assume that each patient follows the same latent a hierarchical time-series model that can discover state transition dynamics, ignoring the heterogeneity in the multiple disease progression dynamics. The proposed disease progression dynamics.

Disease progression modeling (DPM) using longitudinal data is a challenging machine learning task. Existing DPM algorithms neglect temporal dependencies among measurements, make parametric assumptions about biomarker trajectories, do not model multiple biomarkers jointly, and need an alignment of subjects' trajectories. In this paper, recurrent neural networks (RNNs) are utilized to address these issues. However, in many cases, longitudinal cohorts contain incomplete data, which hinders the application of standard RNNs and requires a pre-processing step such as imputation of the missing values. Instead, we propose a generalized training rule for the most widely used RNN architecture, long short-term memory (LSTM) networks, that can handle both missing predictor and target values. The proposed LSTM algorithm is applied to model the progression of Alzheimer's disease (AD) using six volumetric magnetic resonance imaging (MRI) biomarkers, i.e., volumes of ventricles, hippocampus, whole brain, fusiform, middle temporal gyrus, and entorhinal cortex, and it is compared to standard LSTM networks with data imputation and a parametric, regression-based DPM method. The results show that the proposed algorithm achieves a significantly lower mean absolute error (MAE) than the alternatives with p < 0.05 using Wilcoxon signed rank test in predicting values of almost all of the MRI biomarkers. Moreover, a linear discriminant analysis (LDA) classifier applied to the predicted biomarker values produces a significantly larger AUC of 0.90 vs. at most 0.84 with p < 0.001 using McNemar's test for clinical diagnosis of AD. Inspection of MAE curves as a function of the amount of missing data reveals that the proposed LSTM algorithm achieves the best performance up until more than 74% missing values. Finally, it is illustrated how the method can successfully be applied to data with varying time intervals.