Diabetic retinopathy as the primary predictor of mild cognitive impairment in type 2 diabetes: Insights from machine learning models

Mild cognitive impairment (MCI) is a significant and increasingly recognized problem in individuals with type 2 diabetes mellitus (T2DM). This study aims to develop a machine-learning model to predict MCI in patients with T2DMThe dataset was obtained from a prospective cohort conducted at the Sheikh Khalifa Ibn Zaid Hospital, Casablanca, Morocco, and was randomly split into three parts. Machine learning models were trained using the training dataset, and their performance was assessed on the test dataset. The unseen data was reserved for final validation. Subsequently, recursive feature elimination was applied with the top two algorithms to identify and retain the most impactful features for predicting MCI. Then, we retrained the models using the selected variables. Finally, the variables most contributing to the prediction of MCI were represented in a Shapley Additive Explanations SHAPE value plot to better understand their contribution and their ranking in MCI prediction.The dataset included 100 patients. Extra Trees classifier was the best-performing model for mild cognitive impairment (Accuracy: 0·9310/AUC: 0·9667/ Recall: 0·9333/ Precision: 0·9333/F1: 0·9333). The most contributing factors to MCI in patients with type 2 diabetes were, respectively, diabetic retinopathy, age, serum LDL cholesterol level, microalbuminuria, HbA1c, and, serum creatinine level. Our findings suggest avenues for early intervention that could prevent the progression of cognitive impairment among patients with type 2 diabetes.