CharMark: character-level Markov modeling for interpretable linguistic biomarkers of cognitive decline

Dementia, one of the most prevalent neurodegenerative diseases, affects millions worldwide. Understanding linguistic markers of dementia is crucial for elucidating how cognitive decline manifests in speech patterns. Current non-invasive assessments like the Montreal Cognitive Assessment (MoCA) and Saint Louis University Mental Status (SLUMS) tests rely on manual interpretation and often lack detailed linguistic insight. This paper introduces a first-of-its-kind interpretable artificial intelligence (IAI) framework, <i>CharMark</i>, which leverages first-order Markov Chain models to characterize language production at the character level. By computing steady-state probabilities of character transitions in speech transcripts from individuals with dementia and healthy controls, we uncover distinctive character-usage patterns. The space character " ", representing pauses, (treated here as the space token between words rather than acoustic pauses), and letters such as "n" and "i" showed statistically significant differences between groups. Principal Component Analysis (PCA) revealed natural clustering aligned with cognitive status, while Kolmogorov-Smirnov tests confirmed distributional shifts. A Lasso Logistic Regression model further demonstrated that these character-level features possess strong discriminative potential. Our primary contribution is the identification and characterization of candidate linguistic biomarkers of cognitive decline; features that are both interpretable and easily computable. These findings highlight the potential of character-level modeling as a lightweight, scalable strategy for early-stage dementia screening, particularly in settings where more complex or audio-dependent models may be impractical.