Abstract
BACKGROUND: As the older population grows, so does the prevalence of cognitive impairment, emphasizing the importance of early diagnosis. The Mini-Mental State Examination (MMSE) is vital in identifying cognitive impairment. It is known that degraded oral health correlates with MMSE scores ≤26. OBJECTIVE: This study aims to explore the potential of using machine learning (ML) technologies using oral health and demographic examination data to predict the probability of having MMSE scores of 30 or ≤26 in Swedish individuals older than 60 years. METHODS: The study had a cross-sectional design. Baseline data from 2 longitudinal oral health and ongoing general health studies involving individuals older than 60 years were entered into ML models, including random forest, support vector machine, and CatBoost (CB) to classify MMSE scores as either 30 or ≤26, distinguishing between MMSE of 30 and MMSE ≤26 groups. Nested cross-validation (nCV) was used to mitigate overfitting. The best performance-giving model was further investigated for feature importance using Shapley additive explanation summary plots to easily visualize the contribution of each feature to the prediction output. The sample consisted of 693 individuals (350 females and 343 males). RESULTS: All CB, random forest, and support vector machine models achieved high classification accuracies. However, CB exhibited superior performance with an average accuracy of 80.6% on the model using 3 × 3 nCV and surpassed the performance of other models. The Shapley additive explanation summary plot illustrates the impact of factors on the model's predictions, such as age, Plaque Index, probing pocket depth, a feeling of dry mouth, level of education, and use of dental hygiene tools for approximal cleaning. CONCLUSIONS: The oral health parameters and demographic data used as inputs for ML classifiers contain sufficient information to differentiate between MMSE scores ≤26 and 30. This study suggests oral health parameters and ML techniques could offer a potential tool for screening MMSE scores for individuals aged 60 years and older.