Accurate Alzheimer's Disease (AD) progression prediction is essential for early intervention. The TADPOLE challenge, involving 92 algorithms, used multimodal biomarkers to predict future clinical diagnosis, cognition, and ventricular volume. The winning algorithm, FROG, utilized a Longitudinal-to-Cross-sectional (L2C) transformation to convert variable longitudinal histories into fixed-length feature vectors, which contrasted with most existing approaches that fitted models to entire longitudinal histories, e.g., AD Course Map (AD-Map) and minimal recurrent neural networks (MinimalRNN). The TADPOLE challenge only utilized the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. To evaluate FROG's generalizability, we trained it on the ADNI dataset and tested it on three external datasets covering 2,312 participants and 13,200 timepoints. We also introduced two FROG variants. One variant, L2C feedforward neural network (L2C-FNN), unified all XGBoost models used by the original FROG with an FNN. Across external datasets, L2C-FNN and AD-Map were the best for predicting cognition and ventricular volume. For clinical diagnosis prediction, L2C-FNN was the best, while AD-Map was the worst. L2C-FNN compared favorably with other approaches regardless of the number of observed timepoints, and when predicting from 0 to 6 years into the future, underscoring its potential for long-term dementia progression prediction. Pretrained ADNI models are publicly available: GITHUB_LINK.

The authors have declared no competing interest.

This research is supported by the NUS Yong Loo Lin School of Medicine (NUHSRO/2020/124/TMR/LOA), the Singapore National Medical Research Council (NMRC) LCG (OFLCG19May-0035), NMRC CTG-IIT (CTGIIT23jan-0001), NMRC STaR (STaR20nov-0003), NMRC OF-IRG (OFIRG24jan-0030), Singapore Ministry of Health (MOH) Centre Grant (CG21APR1009), the Temasek Foundation (TF2223-IMH-01), and the United States National Institutes of Health (R01MH120080 & R01MH133334). Our computational work was partially performed on resources of the National Supercomputing Centre, Singapore (https://www.nscc.sg). Any opinions, findings and conclusions or recommendations expressed in this material are those of the authors and do not reflect the views of the Singapore NMRC, MOH, Temasek Foundation or USA NIH.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board (IRB) of the National University of Singapore gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data used in this study are available upon request. The ADNI and the AIBL datasets can be accessed via the Image & Data Archive (https://ida.loni.usc.edu/). The MACC dataset can be obtained via a data-transfer agreement with the MACC (http://www.macc.sg/). The OASIS dataset can be requested from (https://www.oasis-brains.org/).

https://ida.loni.usc.edu/

http://www.macc.sg/

https://www.oasis-brains.org/