Ethical issues when using digital biomarkers and artificial intelligence for the early detection of dementia

Abstract

Dementia poses a growing challenge for health services but remains stigmatized and under‐recognized. Digital technologies to aid the earlier detection of dementia are approaching market. These include traditional cognitive screening tools presented on mobile devices, smartphone native applications, passive data collection from wearable, in‐home and in‐car sensors, as well as machine learning techniques applied to clinic and imaging data. It has been suggested that earlier detection and diagnosis may help patients plan for their future, achieve a better quality of life, and access clinical trials and possible future disease modifying treatments. In this review, we explore whether digital tools for the early detection of dementia can or should be deployed, by assessing them against the principles of ethical screening programs. We conclude that while the importance of dementia as a health problem is unquestionable, significant challenges remain. There is no available treatment which improves the prognosis of diagnosed disease. Progression from early‐stage disease to dementia is neither given nor currently predictable. Available technologies are generally not both minimally invasive and highly accurate. Digital deployment risks exacerbating health inequalities due to biased training data and inequity in digital access. Finally, the acceptability of early dementia detection is not established, and resources would be needed to ensure follow‐up and support for those flagged by any new system. We conclude that early dementia detection deployed at scale via digital technologies does not meet standards for a screening program and we offer recommendations for moving toward an ethical mode of implementation. This article is categorized under: Application Areas > Health Care Commercial, Legal, and Ethical Issues > Ethical Considerations Technologies > Artificial Intelligence

Mapping the ethical landscape of digital biomarkers: A scoping review

“…Viewing digital biomarkers through the lens of population screening offers a perspective on the interconnected ethical and practical considerations. For example, when considering digital biomarkers as a screening tool for detecting dementia in the general population, specific ethical issues have been noted [ 38 ]. Here, the ethical principles of screenings outlined by Wilson and Junger, in their influential 1968 report for the World Health Organization [ 39 ], can provide guidance for navigating the complex ethical terrain inherent in the use of these innovative tools.…”

“…Here, the ethical principles of screenings outlined by Wilson and Junger, in their influential 1968 report for the World Health Organization [ 39 ], can provide guidance for navigating the complex ethical terrain inherent in the use of these innovative tools. Wilson and Junger’s principles incorporate factors such as the severity of a health issue targeted by screening, accessibility of diagnostic technologies, and availability of accepted treatments [ 38 ]. In the context of digital biomarkers, these principles underscore the need to critically assess the potential benefits, risks, and societal implications of digital biomarker-based screening programs to ensure their alignment with the overarching goal of promoting well-being and achieving meaningful healthcare outcomes.…”

Feasibility of Observing Cerebrovascular Disease Phenotypes with Smartphone Monitoring: Study Design Considerations for Real-World Studies

“…Though a study may be designed as fully remote, researchers whose studies involve complex devices should be prepared to offer technical support in person if required, as unique dropout reasons may drive the loss of participants. For instance, forgetting log-in credentials and technical processes associated with completing a study or the location of a cell phone charger could be early signs of cerebrovascular changes, including but not limited to vascular dementia, and could be critical to assessing health outcomes and stratifying patient cohorts [ 34 , 35 , 36 ]. Alternatively, such symptoms may be more prevalent in older adults with low socioeconomic status and limited education [ 37 ].…”

Artificial Intelligence in Dementia: A Bibliometric Study

“…The advent of AI research has presented exciting possibilities for the development of efficient and accessible tools that can aid in the early prediction of dementia [ 21 ]. Previous evidence has demonstrated the potential of AI to assist physicians in conducting specific tests and investigations for more effective management of dementia [ 22 , 23 , 24 ].…”