Development and interpretation of a machine learning predictive model for early cognitive impairment in hypertension associated with environmental factors

Xia Zhong¹Tianen Zhao²Shimeng Lv³Guangheng Zhang³Jing Li^1*Donghai Liu^4*Huachen Jiao^5*

• ¹Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
• ²Jinan Lixia De Zhengtang Hospital of Traditional Chinese Medicine, Jinan, Shandong Province, China
• ³Institute of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
• ⁴College of Laboratory Animal Science, Shandong First Medical University, Jinan, China
• ⁵Institute of Cardiology department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China

Background and Objective: Risk-based predictive models are a reliable tool for early identification of hypertensive cognitive impairment. However, the evidence of the combination of individual factors and natural environmental factors is still insufficient. The aim of this study was to establish a well-performing machine learning (ML) model based on personal and natural environmental factors to help assess the risk of early cognitive impairment in hypertension.In this study, a total of 757 Chinese hypertensive patients from from different regions of Shandong Province, China (aged 31-95, male 49.01%) were randomly divided into training group (70%) and verification group (30%). Modelling variables were determined by a 5-fold cross-validated least absolute shrinkage and selection operator (LASSO) regression analysis. Five ML classifiers, XGB (extreme gradient boosting), LR (logistic regression), AdaBoost (adaptive boosting), GNB (gaussian naive bayes), and SVM (support vector machines), have been developed. Area under the ROC curve (AUC), accuracy, sensitivity, specificity, and F1 scores were used to access the model performance. Shape Additive explanation (SHAP) models reveal the feature importance. The clinical performance of the model was evaluated by Decision Curve Analysis (DCA).Cognitive impairment was diagnosed in 17.44% (n=132). LASSO regression analyses suggested that age, waist circumference, urban green coverage, educational levels, annual sunshine hours, and area whole-day average noise were considered significant predictors of early cognitive impairment in hypertension. The obtained XGBoost model yielded good predictive performance with the AUC (0.893), F1 score (0.627), accuracy (0.837), sensitivity (0.780), and specificity (0.853) . The predictive model's clinical net benefit was confirmed through DCA analysis.The XGBoost model developed based on personal factors and natural environmental factors can predict early cognitive impairment of hypertension with superior predictive performance. Larger population cohorts are needed in the future to validate these findings and potentially enhance the ability to identify the occurrence of early cognitive impairment in people with hypertension.