"In the spectrum of people who are healthy": Views of individuals at risk of dementia on using neurotechnology for cognitive enhancement.

Neurotechnological cognitive enhancement has become an area of intense scientific, policy, and ethical interest. However, while work has increasingly focused on ethical views of the general public, less studied are those with personal connections to cognitive impairment. Using a mixed-methods design, we surveyed attitudes regarding implantable neurotechnological cognitive enhancement in individuals who self-identified as having increased likelihood of developing dementia (n=25; 'Our Study'), compared to a nationally representative sample of Americans (n=4726; 'Pew Study'). Participants in Our Study were additionally shown four videos showcasing hypothetical neurotechnological devices designed to enhance different cognitive abilities and were interviewed for more in-depth responses. Both groups expressed comparable degrees of worry and acknowledgement of potential ethical ramifications (all ). Compared to the Pew Study, participants in Our Study expressed slightly higher desire (), as well as higher acknowledgment for potential impacts on productivity (). Ultimately, participants in Our Study were more likely to deem the device morally acceptable (56%; compared to Pew Study, 25.2%; ). Interviews conducted in Our Study allowed participants to supply additional nuance and reasoning to survey responses, such as giving examples for increased productivity, perceived downsides of memory enhancement, or concerns regarding potentially resulting inequality. This study builds upon and adds to the growing focus on potential ethical issues surrounding neurotechnological cognitive enhancement by centering stakeholder perspectives, highlighting the need for inclusive research and consideration of diverse perspectives and lived experiences to ensure inclusive dialogue that best informs ethical and policy discussions in this rapidly advancing field.