Yanfei Wang, Glenn E Smith, Gloria P Lipori, Ramon C Sun, Elizabeth A Shenkman, Mei Liu, Yonghui Wu, Yi Guo
Clinical digital twins are increasingly promoted for decision support, yet most are designed and validated for prediction under observed care rather than decision-support validity. We identify four structural requirements for intelligent clinical digital twins used in bidirectional clinical care. Using Alzheimer's disease and related dementias as an example, we show how routine deployment can induce care-path-dependent epistemic drift despite stable predictive performance.