Machine learning (ML) algorithms play a crucial role in the early and accurate diagnosis of Alzheimer's Disease (AD), which is essential for effective treatment planning. However, existing methods are not well-suited for identifying Mild Cognitive Impairment (MCI), a critical transitional stage between normal aging and AD. This inadequacy is primarily due to label imbalance and bias from different sensitve attributes in MCI classification. To overcome these challenges, we have designed an end-to-end fairness-aware approach for label-imbalanced classification, tailored specifically for neuroimaging data. This method, built on the recently developed FACIMS framework, integrates into STREAMLINE, an automated ML environment. We evaluated our approach against nine other ML algorithms and found that it achieves comparable balanced accuracy to other methods while prioritizing fairness in classifications with five different sensitive attributes. This analysis contributes to the development of equitable and reliable ML diagnostics for MCI detection.

The use of artificial intelligence (AI) in medicine has shown promise to improve the quality of healthcare decisions. However, AI can be biased in a manner that produces unfair predictions for certain demographic subgroups. In MIMIC-CXR, a publicly available dataset of over 300,000 chest X-ray images, diagnostic AI has been shown to have a higher false negative rate for racial minorities. We evaluated the capacity of synthetic data augmentation, oversampling, and demographic-based corrections to enhance the fairness of AI predictions. We show that adjusting unfair predictions for demographic attributes, such as race, is ineffective at improving fairness or predictive performance. However, using oversampling and synthetic data augmentation to modify disease prevalence reduced such disparities by 74.7% and 10.6%, respectively. Moreover, such fairness gains were accomplished without reduction in performance (95% CI AUC: [0.816, 0.820] versus [0.810, 0.819] versus [0.817, 0.821] for baseline, oversampling, and augmentation, respectively).