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However, some limitations are not fully overcome. First, the diagnosis rules established by medical experts or learned from a trained dataset prove static and too general. It leads to decisions that lack adaptive flexibility when finding new circumstances. Secondly, medical terminological interoperability is highly critical. It increases realism and medical progress and avoids isolated systems and the difficulty of data exchange, analysis, and interpretation. Third, criteria for diagnosis are often heterogeneous and changeable. It includes symptoms, patient history, demographic, treatment, genetics, biochemistry, and imaging. Symptoms represent a high-impact indicator for early detection. It is important that we deal with these symptoms differently, which have a great relationship with semantics, vary widely, and have linguistic information. This negatively affects early diagnosis decision-making. Depending on the circumstances, the diagnosis is made solo on imaging and some medical tests. In this case, although the accuracy of the diagnosis is very high, can these decisions be considered an early diagnosis or prove the condition is deteriorating? Our contribution in this paper is to present a real medical diagnostic system based on semantics, fuzzy, and dynamic decision rules. We attempt to integrate ontology semantics reasoning and fuzzy inference. It promotes fuzzy reasoning and handles knowledge representation problems. In complications and symptoms, ontological semantic reasoning improves the process of evaluating rules in terms of interpretability, dynamism, and intelligence. A real-world case study, ADNI, is presented involving the field of Alzheimer\u2019s disease (AD). The proposed system has indicated the possibility of the system to diagnose AD with an accuracy of 97.2%, 95.4%, 94.8%, 93.1%, and 96.3% for AD, LMCI, EMCI, SMC, and CN respectively.<\/jats:p>","DOI":"10.1038\/s41598-024-54065-1","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T05:02:22Z","timestamp":1708491742000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["A dynamic fuzzy rule-based inference system using fuzzy inference with semantic reasoning"],"prefix":"10.1038","volume":"14","author":[{"given":"Nora","family":"Shoaip","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaker","family":"El-Sappagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer","family":"Abuhmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Elmogy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"54065_CR1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s004060050027","volume":"248","author":"H-J M\u00f6ller","year":"1998","unstructured":"M\u00f6ller, H.-J. & Graeber, M. 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