@article {AhlgrimENEURO.0439-18.2019, author = {Nathan S. Ahlgrim and Kristie Garza and Carlie Hoffman and Karen S. Rommelfanger}, title = {Prodromes and Preclinical Detection of Brain Diseases: Surveying the Ethical Landscape of Predicting Brain Health}, elocation-id = {ENEURO.0439-18.2019}, year = {2019}, doi = {10.1523/ENEURO.0439-18.2019}, publisher = {Society for Neuroscience}, abstract = {The future of medicine lies in disease modification and prevention. The science of preclinical detection is young, but moving rapidly. Preclinical interventions offer the hope to decrease the severity of a disease or delay the development of a disorder substantially. With such promise, the research and practice of detecting brain disorders at a preclinical stage present unique ethical challenges, challenges that must be addressed to ensure the benefit of these technologies. Direct brain interventions have potential to impact not just what a patient has but who they are and who they could become. Further receiving an assessment for a preclinical or prodromal state has potential to impact perceptions about capacity, autonomy and personhood and could become entangled with stigma and discrimination. Discussion of the risks and benefits of the emerging technology will focus on how to ensure beneficence by presenting the limitations of preclinical detection and by contextualizing the risk associated with preclinical status. Exploring ethical issues alongside and integrated into the experimental design and research of these technologies is critical. This review will highlight ethical issues attendant to the current and near future states of preclinical detection across the life span, specifically as it relates to autism spectrum disorder (ASD), schizophrenia, and Alzheimer{\textquoteright}s disease.Significance Statement Preclinical interventions in developing brain disorders offer the strongest promise of delaying, modifying, or preventing the development of clinical disorders. Although promising, intervening at early stages in disorders inherently linked to identity and personhood presents unique ethical challenges. These challenges must be addressed before the practices are implemented. Both the treatment and the diagnosis itself have the potential to profoundly impact patients. We contextualize the risk of diagnosing preclinical states and present the limitations of preclinical interventions to guide research and policy as the field of preclinical detection rapidly expands.}, URL = {https://www.eneuro.org/content/early/2019/06/20/ENEURO.0439-18.2019}, eprint = {https://www.eneuro.org/content/early/2019/06/20/ENEURO.0439-18.2019.full.pdf}, journal = {eNeuro} }