Retrieval-Augmented Generation (RAG) improves factual grounding by incorporating external knowledge into language model generation. However, when retrieved context is noisy, unreliable, or inconsistent with the model’s parametric knowledge, it introduces retrieval-prior conflicts that can degrade generation quality. While this problem has been studied in autoregressive language models, it remains largely unexplored in diffusion-based language models, where the iterative denoising process introduces unique challenges for integrating retrieved context. In this work, we propose Adaptive Retrieval-Augmented Masked Diffusion (ARAM), a training-free adaptive guidance framework for Masked Diffusion Models (MDMs) in RAG settings. ARAM dynamically calibrates the guidance scale during denoising according to the Signal-to-Noise Ratio (SNR) of the distributional shift induced by retrieved context. Intuitively, the model strengthens guidance when the retrieved context provides reliable corrective evidence and suppresses it when the contextual signal is noisy or non-supportive. Extensive experiments on multiple knowledge-intensive QA benchmarks show that ARAM improves overall QA performance over decoding-based RAG baselines.

Drug recommendation requires a deep understanding of individual patient context, especially for complex conditions like Parkinson’s disease. While LLMs possess broad medical knowledge, they fail to capture the subtle nuances of actual prescribing patterns. Existing RAG methods also struggle with these complexities because guideline-based retrieval remains too generic and similar-patient retrieval often replicates majority patterns without accounting for the unique clinical nuances of individual patients. To bridge this gap, we propose PACE-RAG (Patient-Aware Contextual and Evidence-Constrained RAG). Rather than directly copying frequent medications from retrieved patients, PACE-RAG personalizes recommendations by first extracting patient-specific clinical features, retrieving cases around these features, and then refining the final prescription using the patient’s current symptoms, active medication history, and focus-specific prescribing tendencies. By analyzing treatment patterns tailored to specific clinical features, PACE-RAG generates patient-specific medication recommendations along with an explainable clinical summary. PACE-RAG achieved the strongest performance among the evaluated inference-only LLM-based methods, reaching F1 scores of 80.84% and 47.22% on the Parkinson’s disease and MIMIC-IV cohorts, respectively. Our code is available at: https://github.com/ChaeYoungHuh/PACE-RAG.

While Large Language Models (LLMs) have shown strong performance on clinical text understanding, they struggle with longitudinal prediction tasks such as dementia prognosis, which require reasoning over complex, non-monotonic symptom trajectories across multiple visits. Standard supervised training lacks explicit annotations for symptom evolution, while direct Reinforcement Learning (RL) is hindered by sparse binary rewards. To address this challenge, we introduce Dementia-R1, an RL-based framework for longitudinal dementia prognosis from unstructured clinical notes. Our approach adopts a Cold-Start RL strategy that pre-trains the model to predict verifiable clinical indices extracted from patient histories, enhancing the capability to reason about disease progression before determining the final clinical status. Extensive experiments show that Dementia-R1 achieves the best overall performance on a real-world unstructured cohort, reaching an AUROC of 84.02% and outperforming models up to 10 larger. The framework also generalizes to Parkinson’s disease dementia prediction in an independent hospital cohort, achieving an AUROC of 78.37%. On the ADNI benchmark, our 7B model attains the highest AUROC among all LLM baselines at 83.17%, demonstrating strong longitudinal reasoning over fluctuating cognitive trajectories. Code is available at https://github.com/hangeol/dementiar1.