a “genetic algorithm” to optimize the construction of a ... · alberto zucchelli roma –sigg...

Alberto Zucchelli Roma – SIGG 2019

A “genetic algorithm” to optimizethe construction of a frailty index in a population-based studyAlberto Zucchelli


Long story short…

A “genetic algorithm” to optimizethe construction of a frailty index in a population-based study

Engineering

Solution

Epidemiologic

al

Challenge


Introduction

The Frailty Index:

𝐹𝐼 =𝑛. 𝒅𝒆𝒇𝒊𝒄𝒊𝒕𝒔 𝒆𝒙𝒉𝒊𝒃𝒊𝒕𝒆𝒅 𝑏𝑦 𝑡ℎ𝑒 𝑠𝑢𝑏𝑗𝑒𝑐𝑡

𝑛. 𝒅𝒆𝒇𝒊𝒄𝒊𝒕𝒔 𝒄𝒐𝒏𝒔𝒊𝒅𝒆𝒓𝒆𝒅 𝑏𝑦 𝑡ℎ𝑒 𝑟𝑒𝑠𝑒𝑎𝑟𝑐ℎ𝑒𝑟

Signs, symptoms, Diseases, Cognitive and functional measures,

Biomarkers, Instrumental examinations results, Low self reported

quality of life

*(30-40 deficits minimum)


Zucchelli A; Vetrano DL – BMC; 2019

< 78

Years

old

* Imputed data


N = 3363

108 “potential deficits”

AIM: to build a FI with a

“balanced accuracy” in the

prediction of mortality.

3.2 × 1032 possible FIs

Methods


John Henry

Holland

Genetic algorithm

A search strategy that helps to find «better»

solutions to problems that are not

analytically solvable

Main advantages1) Users set criteria for “solutions”

• FI with 30-70 deficits

• FIs with a high number of missing values are

excluded

2) Users define what a “good solution” is

• Average AUC from non-parametric ROC

analyses for 3-year and 6-year mortality in

whole study population, sex and age subsamples

N = 3363

Train

dataset

70%

Test dataset

30%

GA GA-FI

Test and

compare

accuracy

c-FI

Methods


1100 randomly

generated FIs*

Test accuracy

Recombine the

best ones

Replace the

worse ones

Best GA-

generated FI

*70% random sample

Methods

New FIs


Best GA-generated FI

- gamma-distributed

- Max FI < 0.7

- 40 deficits included:

• 18 chronic conditions

• 14 physical function tests

• 5 socio-economic status

• 3 cognitive performance

Results

Alberto Zucchelli Roma – SIGG 2019Best GA-generated FI Clinical FI

p = 0.006 p < 0.001

Alberto Zucchelli Roma – SIGG 2019Best GA-generated FI Clinical FI

* **

** **

*

*

* p < 0.05

** p < 0.001


Conclusion:- Optimization algorithms are feasible ways to

build a highly performant and accuracy-

balanced FI

- GAs offer different advantages:

• Users set criteria for solutions and goodness

• Results are data-based

• Inference is possible


Co-authors:

Amaia Calderon-

LarrañagaLaura Fratiglioni

Alessandra Marengoni

Graziano Onder

Debora Rizzuto

Davide Liborio Vetrano

THANK YOU!Thanks to:

• All SNAC-K participants

• SNAC-K data collection and

data management teams

• ARC team


supplementary


inactive

stick

MMSE_cat

Anemia

Heart_failure

widowed_cat

Dementia

COPD

Other_neurological_dis

Solid_neoplasms

Blindness_visual_loss

IADL_Transport

ADL_toiletting

ADL_transferring

education_cat

Deafness_hearing_loss

institution0

Other_CV

Other_psychia

WS_cat

Atrial_fibrillation

patellar_refl

decisions

smoke_cat

Peripheral_vascular_dis

IADL_med

ADL_dressing

Parkinson_parkinsonism

hosp_y_before_cat

Other_respiratory_dis

fatigue

BMI_18

IADL_Housekeeping

Other_eye_dis

social_net_cat

Cerebrovascular_dis

IADL_Telefon

Bradycardias

IADL_Laundry

ADL_bathing


Hypertension

Thyroid disorders

Anaemia

Atrial Fibrillation

Blindness and other visual impairments

Cerebrovascular diseases

Chronic kidney disease

Chronic Obstructive Pulmonary Disease, emphysema and chronic bronchitis

Deafness and other hearing impairments

Dementia

Depression and other mood disorders

Diabetes

Heart failure

Inflammatory bowel diseases

Ischemic heart disease

Osteoporosis

Parkinson disease and parkinsonisms

Peripheral arterial diseases

Peripheral neuropathies

Sleep disorders

Solid neoplasm

Inability to autonomously take and prepare medications

Inability to autonomously shop

Inability to autonomously cook and prepare meals

Inability to autonomously do house chores

Inability to autonomously do the laundry

Inability to autonomously manage finances

Inability to autonomously use the telephone

Inability to autonomously use means of transportation

Minimental State Examination score

Inability to autonomously bath

Inability to autonomously dress

Inability to autonomously use the toilet

Incontinence

Inability to autonomously move in and out from bed or chair

Inability to autonomously feed him-/herself

Usage of stick during walking

Reporting dyspnoea

Evidence of swollen legs at physical examination

Reporting anxiety symptoms

Self-reporting appetite loss

Self-reporting sense of worthlessness

Reporting pain

Feeling older than actual age

Self-reporting low quality of life


DEF_inactive

DEF_stick

DEF_MMSE_cat

DEF_Anemia

DEF_Heart_failure

DEF_widowed_cat

DEF_Dementia

DEF_COPD

DEF_Other_neurological_dis

DEF_Solid_neoplasms

DEF_Blindness_visual_loss

DEF_IADL_Transport

DEF_ADL_toiletting

DEF_ADL_transferring

DEF_education_cat

DEF_Deafness_hearing_loss

DEF_institution0

DEF_Other_CV

DEF_Other_psychia

DEF_WS_cat

DEF_Atrial_fibrillation

DEF_patellar_refl

DEF_decisions

DEF_smoke_cat

DEF_Peripheral_vascular_dis

DEF_IADL_med

DEF_ADL_dressing

DEF_Parkinson_parkinsonism

DEF_hosp_y_before_cat

DEF_Other_respiratory_dis

DEF_fatigue

DEF_BMI_18

DEF_IADL_Housekeeping

DEF_Other_eye_dis

DEF_social_net_cat

DEF_Cerebrovascular_dis

DEF_IADL_Telefon

DEF_Bradycardias

DEF_IADL_Laundry

DEF_ADL_bathing

DEF_romberg_closed

DEF_finger_nose

DEF_tremor

DEF_dysphagia

DEF_smell_change

DEF_pain_cat

DEF_conc_diff_cat

DEF_low_QoF

DEF_paresis

DEF_Weight_loss

DEF_Cardiac_valve_dis

DEF_Colitis_related_dis

DEF_slowness

DEF_wheelchair

DEF_grip_cat

DEF_appeite_loss

DEF_Chronic_pancr

DEF_Ischemic_heart_dis

DEF_Osteoarthritis

DEF_Other_MSK_joint_dis

DEF_Sleep_dis

DEF_Thyroid_dis

DEF_ADL_continence

DEF_sadness

DEF_muscle_tonus

DEF_loneliness_cat

DEF_Allergy

DEF_Dorsopathies

DEF_InflamArthr

DEF_Migraine

DEF_Other_metabolic_dis

DEF_IADL_Finances

DEF_ADL_feeding

DEF_worth_cat

DEF_heart_rtm_cat

DEF_heart_mur_cat

DEF_swol_legs_cat

DEF_Autoimmune_dis

DEF_dyspnea_cat

DEF_IADL_Shopping

DEF_bluecollar

DEF_IADL_Food

DEF_Osteoporosis

DEF_bruit_carotid_cat

DEF_Cataract_lens_dis

DEF_Chronic_kidney_dis

DEF_Diabetes

DEF_EsopStomDu

DEF_Glaucoma

DEF_Hypertension

DEF_SomaticStress

DEF_Other_genitourinary_dis

DEF_disinhibition

DEF_suicide

DEF_dysartrhia

DEF_alcool_cat

DEF_Asthma

DEF_Depression_mood_dis

DEF_Dyslipidemia

DEF_Obesity

DEF_Peripheral_neuropathy

DEF_agitation

DEF_anxiety

DEF_hostile

DEF_sleep_prob

DEF_tired

DEF_stairs_walking_diff

DEF_tandem

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