Juncheng Wang
Publications
AD-CARE: A Guideline-grounded, Modality-agnostic LLM Agent for Real-world Alzheimer's Disease Diagnosis with Multi-cohort Assessment, Fairness Analysis, and Reader Study
Alzheimer's disease (AD) is a growing global health challenge as populations age, and timely, accurate diagnosis is essential to reduce individual and societal burden. However, real-world AD assessment is hampered by incomplete, heterogeneous multimodal data and variability across sites and patient demographics. Although large language models (LLMs) have shown promise in biomedicine, their use in AD has largely been confined to answering narrow, disease-specific questions rather than generating comprehensive diagnostic reports that support clinical decision-making. Here we expand LLM capabilities for clinical decision support by introducing AD-CARE, a modality-agnostic agent that performs guideline-grounded diagnostic assessment from incomplete, heterogeneous inputs without imputing missing modalities. By dynamically orchestrating specialized diagnostic tools and embedding clinical guidelines into LLM-driven reasoning, AD-CARE generates transparent, report-style outputs aligned with real-world clinical workflows. Across six cohorts comprising 10,303 cases, AD-CARE achieved 84.9% diagnostic accuracy, delivering 4.2%-13.7% relative improvements over baseline methods. Despite cohort-level differences, dataset-specific accuracies remain robust (80.4%-98.8%), and the agent consistently outperforms all baselines. AD-CARE reduced performance disparities across racial and age subgroups, decreasing the average dispersion of four metrics by 21%-68% and 28%-51%, respectively. In a controlled reader study, the agent improved neurologist and radiologist accuracy by 6%-11% and more than halved decision time. The framework yielded 2.29%-10.66% absolute gains over eight backbone LLMs and converges their performance. These results show that AD-CARE is a scalable, practically deployable framework that can be integrated into routine clinical workflows for multimodal decision support in AD.
Decentralized Attention Fails Centralized Signals: Rethinking Transformers for Medical Time Series
Accurate analysis of medical time series (MedTS) data, such as electroencephalography (EEG) and electrocardiography (ECG), plays a pivotal role in healthcare applications, including the diagnosis of brain and heart diseases. MedTS data typically exhibit two critical patterns: temporal dependencies within individual channels and channel dependencies across multiple channels. While recent advances in deep learning have leveraged Transformer-based models to effectively capture temporal dependencies, they often struggle with modeling channel dependencies. This limitation stems from a structural mismatch: MedTS signals are inherently centralized, whereas the Transformer's attention mechanism is decentralized, making it less effective at capturing global synchronization and unified waveform patterns. To address this mismatch, we propose CoTAR (Core Token Aggregation-Redistribution), a centralized MLP-based module designed to replace decentralized attention. Instead of allowing all tokens to interact directly, as in standard attention, CoTAR introduces a global core token that serves as a proxy to facilitate inter-token interactions, thereby enforcing a centralized aggregation and redistribution strategy. This design not only better aligns with the centralized nature of MedTS signals but also reduces computational complexity from quadratic to linear. Experiments on five benchmarks validate the superiority of our method in both effectiveness and efficiency, achieving up to a 12.13% improvement on the APAVA dataset, while using only 33% of the memory and 20% of the inference time compared to the previous state of the art. Code and all training scripts are available at https://github.com/Levi-Ackman/TeCh.