Dementia Prediction Support Model Using Regression Analysis and Image Style Transfer
Round 1
Reviewer 1 Report
This is an interesting study proposing a prediction support model for dementia using an image style transfer method and regression analysis. I believe that this is a promising well-written paper. I only have several comments to improve the manuscript further:
- The introduction is well-written. To improve further, it is important for the authors to elaborate further the advantages of image style transfer technology as compared to existing methods.
- "Cognitive disorder means the disorder in all processes that can be utilized intellectually like memory or learning" this sentence is unclear and requires a proper citation.
- More information on the Open Access Series of Imaging Studies (OASIS) can be provided. The demographics and sample characteristics should be elaborated in the manuscript
Author Response
This is an interesting study proposing a prediction support model for dementia using an image style transfer method and regression analysis. I believe that this is a promising well-written paper. I only have several comments to improve the manuscript further:
- The introduction is well-written. To improve further, it is important for the authors to elaborate further the advantages of image style transfer technology as compared to existing methods.
Author response: We thank the reviewer for the review of this manuscript, which greatly improved its quality. Based on your comment, I thought of writing the performance comparison result with the existing method in the contribution of the introduction.
Author action : We additionally described the contributions of the proposed method as follows contents in Introduction section.
Since the background of the image was not removed in the existing method, un-necessary attributes were applied to the image style transmission. In order to solve this problem, the ‘the existing method+background removal’ removes unnecessary attributes, but the performance is evaluated low because differentiated weights are not applied in each step. However, the proposed method has a different weight and reduces the amount of computation by removing the background to prevent unnecessary attribute style transmission, so the performance is evaluated well.
- "Cognitive disorder means the disorder in all processes that can be utilized intellectually like memory or learning" this sentence is unclear and requires a proper citation.
Author response: Thank you for your kind comment.
After receiving your comment, we proceeded with many concerns and research again. We additionally described the references of several papers and encountered many previous studies.
Author action : References have been added to the pointed-out sentence as follows.
Cognitive disorder means the disorder in all processes that can be utilized intellectually like memory or learning [1,2].
[1] Kivipelto, M.; Mangialasche, F.; Ngandu, T. "Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease" Nature Reviews Neurology, 2018, 14, pp. 653-666.
[2] Günak, M. M.; Barnes, D. E.; Yaffe, K.; Li, Y.; Byers, A. L. " Risk of suicide attempt in patients with recent diagnosis of mild cognitive impairment or dementia," JAMA psychiatry, 2021, 78, pp. 659-666.
- More information on the Open Access Series of Imaging Studies (OASIS) can be provided. The demographics and sample characteristics should be elaborated in the manuscript
Author response: Thank you for your kind comment. Your comments were an opportunity to learn more about the data used in the study.
Author action : We additionally described the data as follows contents in 3.1. Data collection.
The data used in this study are the Alzheimer patients’ brain MRI image data and patient information data provided by the Open Access Series of Imaging Studies (OASIS) [19]. OASIS provides data of OASIS-1, OASIS-2, and OASIS-3, of which OASIS-3 is used. This is a dataset of vertical neuroimages, clinical, cognitive, and biomarkers for normal aging and Alzheimer's disease. In addition, data from 609 adults with normal cognitive abilities and 489 people in various cognitive decline stages are included, and identifiers are assigned to protect personal information.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Dear authors, after reading the article, I must admit that it is a relatively well-documented article. I recommend quoting general information in the theoretical introduction. It is worth mentioning that Alzheimer's disease affects the social adaptability that needs to be promoted. Although it is not a premature focus, I believe that this should be heard in connection with this diagnosis. I recommend this article, for example:
VOSTRÝ, M. and L., ZILCHER, 2020. Combination therapy for patients after ischemic stroke from the point of view of complex rehabilitation. Journal of Education Culture and Society, 11 (1), 119-125. https://doi.org/10.15503/jecs2020.1.119.125
VOSTRÝ, M., FISCHER, S., B. LANKOVÁ, 2020. The Effect of Combined Therapy on the Support and Development of Social Skills of people with Multiple Sclerosis in Senior Age. Neuroendocrinol Lett. 2020; 41 (5): 101-105, ISSN 2354-4716
The articles deal with the promotion of social adaptability. However, you can use other sources, but I would welcome additional information. Subsequently, I recommend the article for publication.
Author Response
Dear authors, after reading the article, I must admit that it is a relatively well-documented article. I recommend quoting general information in the theoretical introduction. It is worth mentioning that Alzheimer's disease affects the social adaptability that needs to be promoted. Although it is not a premature focus, I believe that this should be heard in connection with this diagnosis. I recommend this article, for example::
VOSTRÝ, M. and L., ZILCHER, 2020. Combination therapy for patients after ischemic stroke from the point of view of complex rehabilitation. Journal of Education Culture and Society, 11 (1), 119-125. https://doi.org/10.15503/jecs2020.1.119.125
VOSTRÝ, M., FISCHER, S., B. LANKOVÁ, 2020. The Effect of Combined Therapy on the Support and Development of Social Skills of people with Multiple Sclerosis in Senior Age. Neuroendocrinol Lett. 2020; 41 (5): 101-105, ISSN 2354-4716
The articles deal with the promotion of social adaptability. However, you can use other sources, but I would welcome additional information. Subsequently, I recommend the article for publication.
Author response: We thank the reviewer for the review of this manuscript, which greatly improved its quality. After reading the paper you recommended, it served as a foundation for conducting the next study.
Author action : We additionally described the reference and contents [6,7] as follows.
Thus, since continuous monitoring takes a considerable cost, it is necessary to find a way to solve the problem of cost for continuous monitoring. In addition, it is necessary to find a way to raise attention to the need for health management [6,7].
[6] VOSTRÝ, M.; ZILCHER, L. "Combination therapy for patients after ischemic stroke from the point of view of complex rehabilitation," Journal of Education Culture and Society, 2020, 11, pp. 119-125.
[7] VOSTRÝ, M.; FISCHER, S.; LANKOVÁ, B. "The Effect of Combined Therapy on the Support and Development of Social Skills of people with Multiple Sclerosis in Senior Age," Neuroendocrinol Lett. 2020, 41, pp. 101-105.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
The authors have sufficiently addressed all my comments.
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
Round 1
Reviewer 1 Report
The article under review is a very interesting topic. However, it is developed in a very naive way and with little knowledge of what is Alzheimer's disease and what are risk factors. I think that advice of a medical professional or at least one with more background in neuroscience would be needed.
The goal of making each patient aware of her health through her own MRI analysis seems dangerous to me, however it would be truly useful for the medical professional if technique offers discrimination between different types of dementias, and between these and other neurodegenerative pathologies such as multiple sclerosis. But I insist that it must always be in conjunction with medical professionals specializing in neurology who are well acquainted with image diagnosis.
In my opinion the study has been done with few case studies. MRIs of Alzheimer's patients show large individual differences, even within the same disease grade. On the other hand, some of the images that are compared do not come from the same technique, MRI and color image (smoking's brain). No serious conclusions can be drawn from them.
Author Response
Author response: Thank you for your kind comment.
Author action: I collected cognitive function (MMSE) as the most common cause in Alzheimer's-related medical information and related papers, and as factors affecting cognitive function, smokers' brains, alcoholic brains, aged brains, cerebral hemorrhage, and traumatic brain injuries were identified.
Alzheimer's considers brain volume, not color. Therefore, the change in brain volume is the experimental result. It is the medical staff, not the data analysts, who diagnose the disease.
There are a lot of collected MRI data, but only a few results are presented in the paper to suggest an idea for the study.
Author Response File: Author Response.docx
Reviewer 2 Report
The manuscript proposes a prediction support model for dementia based on regression analysis using an image style transfer through collecting images of factors extracted from text information of Alzheimer's disease, images of the normal brain with the imaging modalities MRI and CT. Obtained results showed that the brain with cerebral hemorrhage and the brain of an alcoholic ha the highest similarities to all stages of dementia, and a smoker's brain condition has the highest similarities to the non-demented stage the mild demented stage, and moderate demented stage. I find the topic interesting and being worth of investigation and the document is well strucutred, organized, fluidly written, has enough background information, the methodology followed is clearly explaineda, the results are clearly presented and support the conclusions. Although I propose the following suggestions: - Abstract requires structuring such as: problem, motivation, aim, methodology, main results, further impact of those results. - Keywords should be in alphabetical order. - It seems that the proposed method limitation was not addressed at the discussion section. - Authors must be careful on using self-citations.Author Response
Q1. Abstract requires structuring such as problem, motivation, aim, methodology, main results, the further impact of those results.
Author response: Thank you for your kind comment. The quality of the paper improved because I was able to revise the paper according to your advice.
Author action: I structured the abstract in the order of problems, motivations, goals, methodologies, and main results as follows.
It is difficult to provide information to patients because the cause of Alzheimer's disease is not accurately identified. Therefore, there are difficulties in management and prevention. However, if you can manage the basic influencing factors, you can maintain a healthy brain. Therefore, this study proposes a prediction support model for dementia based on regression analysis using an image style transfer. The proposed method collects images of factors extracted from text information of Alzheimer’s disease, images of the normal brain, and images of the brain of Alzheimer’s disease to notify precautions for the factors affecting Alzheimer’s disease. Accordingly, it transforms the brain style by transferring the image features of the factors affecting it in the normal brain image. The transformed results allow the finding of the factors affecting Alzheimer’s disease compared to the brain of Alzheimer’s disease and allow the medical team or the patients themselves to prevent and manage it. In addition, performance evaluation compares the similarities in style transmission results of factors affecting it according to each stage of dementia condition. A comparison of similarities shows that the brain with cerebral hemorrhage and the brain of an alcoholic has the highest similarities to all stages of dementia. Additionally, a smoker’s brain condition has the highest similarities to the non-demented stage the mild demented stage, and moderate demented stage.
Q2. Keywords should be in alphabetical order.
Author response: Thank you for your kind comment. As a result of making revisions according to your comments, the thesis has become cleaner.
Author action: Keywords are sorted alphabetically as follows.
Q3. It seems that the proposed method limitation was not addressed at the discussion section.
Author response: Thank you for your kind comment.
Author action: The limitations of the proposed method in the conclusion section and future studies to solve them were additionally written as follows.
However, the proposed method proceeded with a limited assumption due to a lack of public data. Therefore, since the brain has been transformed through the most fundamental factors, there are limitations on the information that has been studied in a small number of cases and provided to patients or medical staff. Also, Since the proposed model is in a black box format, there would be a limitation that Alzheimer’s disease risk information may be predicted through the result of style transfer. In addition, it takes much time and computational cost to empirically choose parameters through repeated experiments. The research will be conducted on a white box format support model by additionally investigating the relationships among the factors affecting Alzheimer’s disease and the ground for the selection of parameters of the model to provide highly reliable information in the future.
Q4. Authors must be careful on using self-citations.
Author response: Thank you for your kind comment.
Author action: The citation proceeded without problems.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
As a specialist in brain imaging, I am quite sure that the image marked as a smoker's brain is not such but is changed with the cranial haemorrhage. In other words, they are either mislabelled in all the work or the work is poorly done. Perhaps there was an error in the previous diagnosis or in the storage of the data. In addition, this same image corresponds to a coronal section and the others are horizontal sections. Such comparisons, coronal versus horizontal slices, are not appropriate for this style transfer image technique, thus the study results are compromised. A complete review of the errors and subsequent analysis of the data is needed.
