Predicting Conversion from Mild Cognitive Impairment to Alzheimer’s Disease Using a Vision Transformer and Hippocampal MRI Slices

Convolutional neural networks (CNNs) have been the standard for computer vision tasks including applications in Alzheimer's disease (AD). Recently, Vision Transformers (ViTs) have been introduced, which have emerged as a strong alternative to CNNs. A common precursor stage of AD is a syndrome called mild cognitive impairment (MCI). However, not all individuals diagnosed with MCI progress to AD. In this exploratory investigation, we aimed to assess whether a ViT can reliably classify converters versus non-converters. A transfer learning approach was used for model training by applying a pretrained ViT model, fine-tuned on the ADNI dataset. The cohort comprised 575 individuals (299 stable MCIs; 276 progressive MCIs who converted within 36 months) from whom axial T1-weighted MRI slices covering the hippocampal region were used as model inputs. Results showed an average area under the receiver operating characteristic curve (AUC-ROC) on the test set of 0.74 ± 0.02 (mean ± SD), an accuracy of 0.69 ± 0.03, a sensitivity of 0.65 ± 0.07, a specificity of 0.72 ± 0.06, and an F1-score for the progressive MCI class of 0.67 ± 0.04. These findings demonstrate that a ViT approach achieves reasonable accuracy for classifying AD converters vs. non-converters, though its generalizability and clinical utility require further validation.