An Interactive LLM-Based Simulator for Dementia-Related Activities of Daily Living

Alzheimer's disease is a neurodegenerative disorder marked by progressive declines in memory and language that reduce independence in daily life, motivating socially assistive robotic support. This paper presents MEMOR-E, a mobile quadruped robot with an interactive tablet interface that assists patients and caregivers through medication reminders, routine guidance, memory oriented interactions, and companionship. We evaluated the feasibility of fine tuning large language models (LLMs) to emulate stage consistent cognitive behavior and interpret responses across standard neuropsychological language tasks, using audio transcriptions from 235 Alzheimer's patients and synthetically generated healthy controls. We also report findings on using in context learning (ICL) in LLMs, where a second LLM produced domain and severity level cognitive error summaries. Our results show that MEMOR-E can generate stage aware, non diagnostic cognitive summaries that support personalized assistive interactions, while explainable AI mechanisms translate model outputs into transparent, human readable evidence to enable caregiver oversight and trustworthy human robot interaction.

Existing LLM-driven robot task planners rely on a taken-for-granted assumption of an ideal user whose instructions are clear, complete, and task-focused. However, when interacting with real-world users, especially those experiencing cognitive impairments, such as people living with dementia (PLWD), the planners often make mistakes and even pose physical safety risks. We proposed TALK-Dem (Talking Attributes and Linguistic Knowledge in Dementia), the first benchmark for evaluating LLM-driven robot task planning under dementia-associated verbal communication. TALK-Dem contains 4,800 instructions and covers five typical communication patterns, including Referential Imprecision, Object Substitution, Empty Speech, Topic Drift, and Intrusion, at three intensity levels. Experiments across six open-weight LLMs reveal a substantial robustness gap. Across communication patterns, open-weight models exhibited performance drops of up to 22.3 percentage points compared to ideal instructions. This revealed a critical gap and even danger for real-world applications, especially in assistive robotics, where locally deployable models are necessary due to privacy concerns and connectivity constraints. To mitigate this issue, we proposed the Context-Aware Retrieval from Experience (CARE) method, which retrieves relevant previously resolved tasks to provide task-specific interpretation and planning context. CARE generally outperformed standard prompting baselines across the six open-weight models, improving average task success by 18.1 percentage points over the vanilla prompt. These results highlighted the importance of both evaluating communication robustness and developing effective adaptation strategies for locally deployable assistive robots. The TALK-Dem dataset is publicly available at https://anonymous.4open.science/r/TALK-Dem-A6B3/.

Large language models (LLMs) are increasingly used in clinical and care settings. This exploratory study investigates whether LLMs exhibit sycophantic behavior - adapting their responses to social expectation signals rather than maintaining professional quality - in the context of dementia care. Five prompts with systematically increasing confirmatory and authority-related framing (P1 neutral to P5 authority-signaled implementation support) were submitted to four LLMs (GPT-5, Claude Sonnet 4.6, Gemini 3.1 Pro, Mistral Large), each repeated five times (N = 100 responses). Responses were evaluated using an LLM-as-a-Judge methodology against seven nursing-ethical quality criteria (K1-K7) and a tone scale (0-3). All models showed significant negative Spearman correlations between prompt level and response quality (rho ranging from -0.543 to -0.734, all p < 0.01). Mistral Large exhibited the most pronounced effect (rho = -0.734), with mean scores dropping from 6.0/7 at P1 to 0.2/7 at P5. The findings suggest that LLMs pose context-sensitive risks in high-stakes care environments and that prompt framing significantly shapes response quality - a dimension that has received insufficient attention in healthcare AI deployment.