Multilingual Cognitive Impairment Detection in the Era of Foundation Models

Abstract

We evaluate cognitive impairment (CI) classification from transcripts of speech in English, Slovene, and Korean. We compare zero-shot large language models (LLMs) used as direct classifiers under three input settings -- transcript-only, linguistic-features-only, and combined -- with supervised tabular approaches trained under a leave-one-out protocol. The tabular models operate on engineered linguistic features, transcript embeddings, and early or late fusion of both modalities. Across languages, zero-shot LLMs provide competitive no-training baselines, but supervised tabular models generally perform better, particularly when engineered linguistic features are included and combined with embeddings. Few-shot experiments focusing on embeddings indicate that the value of limited supervision is language-dependent, with some languages benefiting substantially from additional labelled examples while others remain constrained without richer feature representations. Overall, the results suggest that, in small-data CI detection, structured linguistic signals and simple fusion-based classifiers remain strong and reliable signals.