A Multi-Agent Approach to Neurological Clinical Reasoning

TL;DR

This study develops a multi-agent system that significantly improves neurological reasoning in large language models, outperforming traditional models and retrieval methods on a specialized medical benchmark.

Contribution

The paper introduces a novel multi-agent framework that decomposes neurological reasoning into specialized functions, greatly enhancing model performance on complex clinical questions.

Findings

Multi-agent system achieved 89.2% accuracy, surpassing base models.

Structured reasoning improved performance on complex questions.

Multi-agent approach outperformed retrieval-augmented generation methods.

Abstract

Large language models (LLMs) have shown promise in medical domains, but their ability to handle specialized neurological reasoning requires systematic evaluation. We developed a comprehensive benchmark using 305 questions from Israeli Board Certification Exams in Neurology, classified along three complexity dimensions: factual knowledge depth, clinical concept integration, and reasoning complexity. We evaluated ten LLMs using base models, retrieval-augmented generation (RAG), and a novel multi-agent system. Results showed significant performance variation. OpenAI-o1 achieved the highest base performance (90.9% accuracy), while specialized medical models performed poorly (52.9% for Meditron-70B). RAG provided modest benefits but limited effectiveness on complex reasoning questions. In contrast, our multi-agent framework, decomposing neurological reasoning into specialized cognitive functions including question analysis, knowledge retrieval, answer synthesis, and validation, achieved dramatic improvements, especially for mid-range models. The LLaMA 3.3-70B-based agentic system reached 89.2% accuracy versus 69.5% for its base model, with substantial gains on level 3 complexity questions. The multi-agent approach transformed inconsistent subspecialty performance into uniform excellence, addressing neurological reasoning challenges that persisted with RAG enhancement. We validated our approach using an independent dataset of 155 neurological cases from MedQA. Results confirm that structured multi-agent approaches designed to emulate specialized cognitive processes significantly enhance complex medical reasoning, offering promising directions for AI assistance in challenging clinical contexts.