Survey on Acceptance of Passive Technology Monitoring for Early Detection of Cognitive Impairment

Abstract

<b><i>Introduction:</i></b> Digital biomarkers may act as a tool for early detection of changes in cognition. It is important to understand public perception of technologies focused on monitoring cognition to better guide the design of these tools and inform patients appropriately about the associated risks and benefits. Health care systems may also play a role in the clinical, legal, and financial implications of such technologies. <b><i>Objective:</i></b> To evaluate public opinion on the use of passive technology for monitoring cognition. <b><i>Methods:</i></b> This was a one-time, Internet-based survey conducted in English and Spanish. <b><i>Results:</i></b> Within the English survey distributed in the USA (<i>n</i> = 173), 58.1% of respondents would be highly likely to agree to passive monitoring of cognition via a smartphone application. Thirty-eight percent of those with a higher degree of experience with technology were likely to agree to monitoring versus 20% of those with less experience with technology (<i>p</i> = 0.003). Sixty-two percent of non-health-care professionals were likely to agree to monitoring versus 45% of health-care workers (<i>p</i> = 0.012). There were significant concerns regarding privacy (<i>p</i> < 0.01). We compared the surveys answered in Spanish in Costa Rica via logistic regression (<i>n</i> = 43, total <i>n</i> = 216), adjusting for age, education level, health-care profession, owning a smartphone, experience with technology, and perception of cognitive decline. Costa Rican/Spanish-speaking respondents were 7 times more likely to select a high probability of agreeing to such a technology (<i>p</i> < 0.01). English-speaking respondents from the USA were 5 times more likely to be concerned about the impact on health insurance (<i>p</i> = 0.001) and life insurance (<i>p</i> = 0.01). <b><i>Conclusions:</i></b> Understanding public perception and ethical implications should guide the design of digital biomarkers for cognition. Privacy and the health-care system in which the participants take part are 2 major factors to be considered. It is the responsibility of researchers to convey the ethical and legal implications of cognition monitoring.

Mapping the ethical landscape of digital biomarkers: A scoping review

“…The validation of digital biomarkers raises not only epistemological considerations, but also ethical implications that cannot be ignored [ 19 , 20 , 24 , 27 , 28 , 30 ]. While the primary concern is ensuring the accuracy and reliability of these biomarkers, the moral responsibility to avoid harm is inherently tied to the validation process.…”

“…Privacy and data security emerge as paramount concerns in the implementation of digital biomarkers, giving rise to ethical dilemmas regarding the protection of sensitive patient data against unauthorized access and misuse [18][19][20][21][22][23][24][25][26][27][28][29][30]. The collection and sharing of sensitive personal health information raises questions about who should have access to the data and how it should be used.…”

Developments in scalable strategies for detecting early markers of cognitive decline

“…Data privacy is a major concern for passive data collection. Consent to passive monitoring of cognition via a smartphone application appears higher in participants with more technology experience and lower in healthcare professionals [92]. Worryingly, not all smartphone applications intended for neuropsychiatric conditions seem to have a privacy policy, and if this is available at all, it is often inappropriately complex for lay people [93].…”