Ethical considerations for deep brain stimulation and other invasive neurotechnological trials in people with Alzheimer's disease

Alzheimer's disease is the leading cause of dementia worldwide, affecting more than 30 million people. FDA-approved drugs only provide temporary relief to memory problems, and no disease-modifying therapies are currently available. As such, different therapeutic modalities are being investigated to address the biological and/or cognitive manifestations of the disease. A number of these therapies are highly invasive and require stereotactic surgery, potentially posing a greater risk of harms to a vulnerable population with cognitive deficits that limit their ability to provide fully informed consent. Using an interdisciplinary and pragmatic approach to bioethical inquiry, this dissertation examines studies on deep brain stimulation in people with Alzheimer's disease, reviewing clinical trials and relevant animal studies to highlight pressing ethical concerns that ongoing and forthcoming trials need to address. By having three major publications during the course of the PhD as the main chapters, This thesis aims to enumerate ethical issues that encompass the genetic, neurobiological, cognitive, individual, and societal dimensions of deep brain stimulation for Alzheimer's disease. These ethical considerations can then be extended into other forms of novel neurosurgical trials such as cell implantation and gene therapy. Finally, this thesis incorporates other publications during the PhD to illustrate further conundrums on the use of deep brain stimulation and highlight directions for future bioethics research on the use of invasive neurotechnologies for dementia in terms of the importance of genetic underpinnings, clinical translation issues, communication of research objectives, media portrayal, and implications on criminal responsibility.