AD-Reasoning: Multimodal Guideline-Guided Reasoning for Alzheimer's Disease Diagnosis

Abstract

Alzheimer's disease (AD) diagnosis requires integrating neuroimaging with heterogeneous clinical evidence and reasoning under established criteria, yet most multimodal models remain opaque and weakly guideline-aligned. We present AD-Reasoning, a multimodal framework that couples structural MRI with six clinical modalities and a rule-based verifier to generate structured, NIA-AA-consistent diagnoses. AD-Reasoning combines modality-specific encoders, bidirectional cross-attention fusion, and reinforcement fine-tuning with verifiable rewards that enforce output format, guideline evidence coverage, and reasoning--decision consistency. We also release AD-MultiSense, a 10,378-visit multimodal QA dataset with guideline-validated rationales built from ADNI/AIBL. On AD-MultiSense, AD-Reasoning achieves state-of-the-art diagnostic accuracy and produces structured rationales that improve transparency over recent baselines, while providing transparent rationales.