BioSync: Transformer-Based Cross-Modal Fusion for a Multimodal Physiological Digital Biomarker

Cardiac, neural, behavioral, and speech measurements from wearable and mobile devices provide partial, noise-sensitive views of physiological state. BioSync combines these measurements into the BioSync Index (BSI), a continuous composite digital biomarker defined under the BEST framework. The model applies multi-head self-attention to modality tokens and adds a linear branch whose hypothesis class includes standard feature concatenation. This architecture is motivated by latent-variable measurement theory and by the possibility that joint observations contain information unavailable from individual modalities. We evaluated BioSync on two literature-informed synthetic cohorts: a four-modality cognitive-decline cohort using HRV, EEG, actigraphy, and speech, and a metabolic-autonomic cohort structured around the public AI-READI wearable schema. In the cognitive cohort, BioSync and concatenation obtained AUCs of 0.928 and 0.926, respectively. In the metabolic cohort, BioSync obtained accuracy/F1 of 0.764/0.766, compared with 0.756/0.758 for concatenation. The BSI correlated with latent severity in both cohorts (r=0.91 and r=0.68). A pure-attention ablation obtained cognitive-cohort AUC 0.911, locating the increase to 0.928 in the combined wide-and-deep architecture. With matched modality-dropout training, BioSync led concatenation at five of six cognitive-cohort corruption rates and at the highest metabolic-cohort rate. Its cognitive-cohort AUC was also higher than five published digital-biomarker reference values, although differences in datasets and tasks preclude a controlled benchmark claim. Comparison with single-modality, early-fusion, and late-fusion designs across six prespecified criteria identifies the model's computational properties; validation on real cohorts remains necessary.