Evaluating the Effectiveness of Machine Learning for Alzheimer’s Disease Prediction Using Applied Explainability

Early and accurate diagnosis of Alzheimer’s disease (AD) is critical for patient outcomes yet presents a significant clinical challenge. This study evaluates the effectiveness of four machine learning models—Logistic Regression, Random Forest, Support Vector Machine, and a Feed-Forward Neural Network—for the five-class classification of AD stages. We systematically compare model performance under two conditions, one including cognitive assessment data and one without, to quantify the diagnostic value of these functional tests. To ensure transparency, we use SHapley Additive exPlanations (SHAPs) to interpret the model predictions. Results show that the inclusion of cognitive data is paramount for accuracy. The RF model performed best, achieving an accuracy of 84.4% with cognitive data included. Without this, performance for all models dropped significantly. SHAP analysis revealed that in the presence of cognitive data, models primarily rely on functional scores like the Clinical Dementia Rating—Sum of Boxes. In their absence, models correctly identify key biological markers, including PET (positron emission tomography) imaging of amyloid burden (FBB, AV45) and hippocampal atrophy, as the next-best predictors. This work underscores the indispensable role of cognitive assessments in AD classification and demonstrates that explainable AI can validate model behavior against clinical knowledge, fostering trust in computational diagnostic tools.