Dementia Care
Latest papers
18 papers2 papers in the last four weeks, down 33% on the four weeks before. 0.0% of all new papers.
Early detection of mild cognitive impairment remains a critical bottleneck in dementia care, demanding scalable tools capable of capturing subtle behavioral decay. To capture the subtle temporal changes of cognitive decline, we introduce a behavioral dataset collected across seven unscripted multimodal interactions over an 18-month horizon. This dataset formalizes continuous, multi-session interactions into a dense 4D tensor (Batch * Session * Time * Feature) that explicitly preserves concurrent local dynamics alongside long-term changes. To effectively process these complex behavioral patterns, we propose CogDrift-4D: a novel, hierarchical 4D Transformer framework. To capture the complex trajectory of cognitive decline, CogDrift-4D implements a dual-level behavioral fatigue and drift modeling architecture. At the intra-session level, the model computes localized least-squares regression slopes to quantify the acute ``fading'' of frame-level facial action units and acoustic energy. At the inter-session level, a recursive cross-attention feedback encoder acts as a cumulative fatigue accumulator, mapping the patient's continuous behavioral drift across successive sessions. To mitigate environmental noise and track failures across sessions, a localized Quality Gate dynamically filters low-integrity features before final fusion, also an early fusion that integrates semantic insights with raw physical dynamics. Evaluated on structured verbal and linguistic interactions, our architecture successfully detects MCI with a classification accuracy of 0.733 +- 0.13 and an F1-score of 0.716 +- 0.14, outperforming advanced baselines. The framework provides a mathematically rigorous, scalable, and robust foundation for home-based, real-time dementia screening.
TALK-Dem: Benchmarking Embodied Task Planning under Dementia-Associated Communication Patterns
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/.
Governed AI-Agent Coordination for Dementia Care: Architecture, Safety Contracts, and Evidence-Derived Workflow Verification
Dementia care at home increasingly involves connected sensors, medication devices, electronic records, and assistive technologies. Professionals and family carers must still interpret these observations, reconstruct context, coordinate responses, and verify resolution. Sustaining safe care at home while ensuring timely clinical escalation requires continuity between these tasks. Agentic engineering creates a systems opportunity by combining model interpretation with persistent external memory, planning, authorised tool use, and outcome feedback. This paper presents Governed Closed-loop Agent Coordination (GCAC), an architecture for bounded agent participation in community dementia-care workflows. Evidence on coordination failures and policy obligations is translated into traceable system requirements. GCAC separates observation, four governed memory classes, planning, deterministic policy enforcement, execution, and outcome monitoring through a typed event-memory-decision-action-outcome contract. A worked medication-device example explains how these roles maintain context, allocate responsibility, and distinguish an unrecorded dose from a clinically established omission. A reference harness evaluates 18 evidence-derived traces spanning care gaps, service failure, consent change, stale state, duplicate events, untrusted text, and acute-change routing. GCAC satisfies all 18 contract oracles with zero policy-violating tool calls; event-threshold and stateless-planner controls satisfy 2/18 and 1/18, respectively. Six ablations identify the contribution of memory, policy, and versioning. The results establish architectural conformance. Effects on hospital use, quality of life, staff workload, unpaid care, and net costs require prospective evaluation. GCAC provides a testable basis for accountable coordination that preserves human authority over consequential care decisions.
CareMirror: Bringing Caregiver Wellbeing into the Dementia Care Ecosystem
Family caregivers of people living with dementia shoulder emotional and practical responsibilities, yet their own wellbeing often remains peripheral to dementia care. We built CareMirror, an envisioned caregiver wellbeing ecosystem with interconnected caregiver- and clinician-facing interfaces for longitudinal reflection, personalized support, and caregiver-controlled sharing with clinical care. We conducted semi-structured interviews with 14 caregivers, using CareMirror as a design probe to examine how they perceived this ecosystem and what expectations, concerns, and boundaries emerged around clinical connection. Caregivers valued attention to their wellbeing, longitudinal awareness, context-sensitive support, and clinical visibility when it could lead to meaningful follow-up. However, repeated reflection could become burdensome or emotionally difficult, automatic clinical sharing could inhibit candid disclosure, and participants wanted control over what information entered clinical care. They also expected AI to support reflection and communication without replacing caregiver voice or clinician judgment. We contribute design considerations for proactive, clinically connected caregiver wellbeing support.
DementiaCare-Bench: A Modality-Validated Video Benchmark
Dementia affects an estimated 57 million people worldwide, and for most families the hardest part of care is not memory loss but the behavioral and psychological symptoms of dementia (BPSD): agitation, wandering, resistance to care, sundowning. Understanding these symptoms requires more than recognizing the behavior itself; it also requires knowing what happened beforehand. The same behavior may call for a different response depending on its trigger. Video-language models (VLMs) could potentially support caregivers, yet no existing benchmark evaluates this capability. To fill this gap, we present DementiaCare-Bench: 56 professionally produced caregiver training videos segmented into 94 clips across nine BPSD categories, with 2023 questions generated by a multi-agent pipeline that grounds every clinical claim in a verbatim transcript span. Each question is then probed under four visual conditions and labelled by the least it requires, so its visual demand is measured rather than assumed. Measurement contradicts intent: we wrote 77.7% of the questions to require ordered frames, and 34.8% do. Across 12 current VLMs the pattern is uniform. The best reach 85% overall, but that average is carried by questions a language model can answer from clinical knowledge alone; accuracy falls by 17 points on average on questions that require the ordered clip, and a leading open model scores at chance on judging whether a caregiver's response was appropriate. A lightweight LoRA fine-tune, DemCare-VLM, moves video dependence from -3.3 to +4.5 points, so what the benchmark exposes can be repaired and not only measured.
Under-Mattress Temporal Sensing for Next-Day Agitation Risk Scoring in Dementia Wards
Agitation fluctuates over short time horizons in people living with dementia, yet continuous physiological information for anticipating next-day risk is limited. We assessed whether contactless under-mattress signals from the preceding night inform next-day agitation risk and whether preserving minute-level temporal structure improves performance over conventional nightly summaries. We analyzed 423 patient-nights from 65 subjects in a specialized hospital dementia unit using two under-mattress sensing systems. A unified four-paradigm benchmark compared nightly handcrafted summaries, three-period handcrafted features, full-night sequence modeling, and sliding-window multiple-instance learning. Source-specific preprocessing and five-fold patient-grouped cross-validation were used, with performance estimated from pooled out-of-fold predictions. Evaluation included discrimination, calibration, fixed-threshold metrics, and a comparison of period-signal attribution patterns across two temporal models. Full-night sequence modeling achieved the highest discrimination (AUROC, 0.692; AUPRC, 0.849) and balanced accuracy (0.658). Both minute-level pipelines had higher AUROC than nightly summaries, but differences from three-period handcrafted features were uncertain. Cross-model attribution prioritized activity, heart rate, and respiratory rate during the core overnight period. Calibration remained limited. The preceding night's signals supported modest next-day risk discrimination, with minute-level temporal modeling outperforming nightly summaries. Prospective calibration and external validation are needed before use in individual care decisions. This patient-grouped benchmark identifies contactless overnight sensing as a promising biomedical engineering direction for agitation-risk research in hospitalized dementia cohorts.
Stakeholder Insights for Designing In-Home Social Robots for Dementia Disorientation Detection and Caregiver-Aware Intervention
Dementia disorientation detection and intervention remain under-examined as socio-technical challenges for socially assistive robots (SARs). We conducted 14 semi-structured interviews with dementia caregivers and practitioners (DCPs) to investigate how disorientation is experienced, recognised, and managed in everyday life. The findings reveal that disorientation is recurrent and fluctuating. It often emerges through behavioural cues such as repeated questioning, inappropriate activity timing and disrupted daily routines. Caregivers described orientation as emotionally charged, and direct correction may increase distress. The DCPs were generally receptive to robotic assistance when framed as supportive rather than corrective. Based on the insights, we identify essential design implications for SARs that provide context-aware orientation support, integrate into daily routines and support caregivers through timely escalation.
Factors Influencing Conversational Engagement in Robot-Delivered Individual Cognitive Stimulation Therapy (iCST) for Dementia in Home Settings
Social robots offer a promising means of supporting cognitive therapies for dementia care by guiding structured conversation and therapeutic activities. However, little is known about the conversational dynamics that emerge during robot-delivered cognitive stimulation therapy (CST) sessions. This study analysed the interaction patterns from robot-delivered individual CST (iCST) sessions conducted with people living with dementia in home settings. Our Co-STAR (Cognitive Stimulation Therapy by an Autonomous Robot) system was deployed in the homes of eight PwDs for one week, who completed 30-minute sessions. Conversational metrics, including words per turn, speech production rate, response duration, response latency, and self-referential language, were analysed to examine how conversational engagement is shaped by prompt personalisation, interaction phase, and participant characteristics. The findings highlight three key interactional properties of robot-delivered iCST. First, personalised prompts significantly increase response duration, self-referential language, and overall engagement compared to generic prompts. Second, conversational behaviour changes within sessions, with a reduction in the verbal output and autobiographical engagement observed during later interaction phases, which suggests cognitive fatigue. Third, first-session conversational metrics were associated with long-term participation, while living situation influenced conversational engagement patterns. These findings provide empirical insights into the factors that shape conversational engagement in robot-delivered iCST. They inform the design of adaptive conversational robots for dementia therapy.
Co-STAR: Cognitive Stimulation Therapy by an Autonomous Robot for Dementia -- A One-Week In-Home Study
Cognitive therapies have been shown to enhance the quality of life and well-being of people living with dementia (PwDs). However, their use remains limited due to a shortage of trained professionals and the significant time and training required of informal caregivers. To address this gap, we developed and deployed a social robot capable of autonomously delivering cognitive stimulation therapy (CST) in the home. Nine PwDs participated in a one-week ( days) study that involved daily robot-led sessions. Participants engaged positively with the system, completing nearly half of the scheduled sessions, an adherence rate higher than typically observed in caregiver-led CST. Our findings also highlight the crucial role of family members, who often supported session initiation and occasionally joined the activities, enriching the interactions. This work demonstrates the feasibility and potential of socially assistive robots to deliver in-home cognitive therapy, offering a scalable approach to extend access to dementia care.
A Taxonomy of Mental Health and Technology Needs for Alzheimer's and Dementia Caregivers
Family members caring for individuals with Alzheimer's disease and related dementias (AD/ADRD) provide the foundation of long-term care worldwide. In 2023, more than 11 million U.S. family and friends contributed 18 billion hours of unpaid care, often at the cost of their own physical and mental health. These informal caregivers -- also referred as the "invisible second patients" -- experience elevated rates of mental health problems. Yet research commonly reduces their complex psychosocial experiences to a single construct of caregiver burden, obscuring which specific needs are unmet or effectively supported. At the same time, digital and AI-enabled technologies are rapidly expanding, from smartphone apps and videoconferencing to sensor platforms and AI chatbots. However, the absence of shared frameworks across medicine, psychology, and technology research limits cumulative progress. This study introduces a Caregiver Mental Health and Technology Taxonomy that systematically links AD/ADRD caregiver needs with corresponding classes of technology-based interventions. Drawing from an interdisciplinary literature review and two qualitative studies with caregivers, the taxonomy identifies mismatches between caregiver priorities and existing technological support, highlights under-served domains such as relational strain and compassion fatigue, and proposes design directions for adaptive, responsive systems. The framework offers a shared vocabulary to guide clinicians, researchers, and technology designers in developing more person-centered and clinically grounded innovation in dementia care.
Can the Environment Speak for Itself? -GRPO: A Turn-Trajectory Group Relative Policy Optimization for Caregiver Agents
Optimizing large language models (LLMs) for long-horizon caregiver agents requires balancing delayed task objectives with immediate environment dynamics, such as patient distress and resistance. In dementia care, this balance is especially difficult: trajectory level rewards are too sparse for turn level credit assignment, while external LLM-based evaluators are costly and can misread fragmented or indirect patient responses. To address this issue, we propose Turn-Trajectory Group Relative Policy Optimization (\textbf{T-GRPO}), a framework that decouples caregiver RL into two normalized reward horizons and enforces safety through a binary hard veto. -GRPO derives dense turn-level rewards directly from environment state transitions, measuring changes in patient distress and resistance from a frozen dementia patient simulator. These environment-grounded rewards are combined with trajectory-level evaluations through independent centered-rank normalization, which preserves heterogeneous reward signals and mitigates reward collapse. Extensive experiments on dementia caregivers show that T -GRPO outperforms competitive baselines, indicating a substantial improvement for emotionally sensitive caregiver scenarios that effectively handles immediate patient feedback, long-term care outcomes, and safety constraints.
AI-Care: A Conversational Agentic System for Task Coordination in Alzheimer's Disease Care
Individuals with Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) experience memory and thinking changes that impact their ability to use digital daily management tools. For example, adding an event to a digital calendar requires multiple steps that may act as barriers to independent use for individuals with AD/ADRD. This paper presents AI-Care, a conversational agentic artificial intelligence (AI) layer built on top of a remote caregiving platform co-designed with people with AD/ADRD. AI-Care is designed to reduce the cognitive load on individuals with AD/ADRD when managing everyday tasks such as setting calendar reminders and organizing to-do lists through natural-language interaction with a voice-first chatbot. The system uses a LangGraph-based stateful orchestration approach in which each request passes through sanitization, intent classification, context loading, safety checks, deterministic slot collection, tool execution, and response composition. Safety-critical responses, particularly around medications and allergies, are grounded in caregiver-verified records rather than free-form model generation. The system does not make autonomous medical or treatment decisions. Incomplete or ambiguous requests are handled through controlled multi-turn clarification rather than silent failure or guessing. The system supports both typed and spoken input, with voice output through ElevenLabs text-to-speech. Longer responses are chunked before synthesis to avoid rushed playback. A preliminary pilot with four individuals with mild-to-moderate AD/ADRD showed that users found the system trustworthy, competent, and likable, and were able to complete the evaluated coordination tasks through conversation. We describe the design goals, system architecture, safety controls, and findings from this formative evaluation.
MEMOR-E: In-Context and Fine-Tuned LLM Personalization for Alzheimer's Assistive Robotics
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.
When AI Tells You What You Want to Hear: Sycophantic Behavior of Large Language Models in Dementia Care Settings
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.
An Edge-Host-Cloud Architecture for Robot-Agnostic, Caregiver-in-the-Loop Personalized Cognitive Exercise: Multi-Site Deployment in Dementia Care
We present Speaking Memories, a distributed, stakeholder-in-the-loop robotic interaction platform for personalized cognitive exercise support. Rather than a single robot-centric system, Speaking Memories is designed as a generalizable robotics architecture that integrates caregiver-authored knowledge, local edge intelligence, and embodied robotic agents into a unified socio-technical loop. The platform fuses auditory, visual, and textual signals to enable emotion-aware, personalized dialogue, while decoupling multimodal perception and reasoning from robot-specific hardware through a local edge interaction server. This design achieves low-latency, privacy-preserving operation and supports scalable deployment across heterogeneous robotic embodiments. Caregivers and family members contribute structured biographical knowledge via a secure cloud portal, which conditions downstream dialogue policies and enables longitudinal personalization across interaction sessions. Beyond real-time interaction, the system incorporates an automated multimodal evaluation layer that continuously analyzes user responses, affective cues, and engagement patterns, producing structured interaction metrics at scale. These metrics support systematic assessment of interaction quality, enable data-driven model fine-tuning, and lay the foundation for future clinician- and caregiver-informed personalization and intervention planning. We evaluate the platform through real-world deployments, measuring end-to-end latency, dialogue coherence, interaction stability, and stakeholder-reported usability and engagement. Results demonstrate sub-6-second response latency, robust multimodal synchronization, and consistently positive feedback from both participants and caregivers. Furthermore, subsets of the dataset can be shared upon request, subject to participant consent and IRB constraints.
Cerebra: A Multidisciplinary AI Board for Multimodal Dementia Characterization and Risk Assessment
Modern clinical practice increasingly depends on reasoning over heterogeneous, evolving, and incomplete patient data. Although recent advances in multimodal foundation models have improved performance on various clinical tasks, most existing models remain static, opaque, and poorly aligned with real-world clinical workflows. We present Cerebra, an interactive multi-agent AI team that coordinates specialized agents for EHR, clinical notes, and medical imaging analysis. These outputs are synthesized into a clinician-facing dashboard that combines visual analytics with a conversational interface, enabling clinicians to interrogate predictions and contextualize risk at the point of care. Cerebra supports privacy-preserving deployment by operating on structured representations and remains robust when modalities are incomplete. We evaluated Cerebra using a massive multi-institutional dataset spanning 3 million patients from four independent healthcare systems. Cerebra consistently outperformed both state-of-the-art single-modality models and large multimodal language model baselines. In dementia risk prediction, it achieved AUROCs up to 0.80, compared with 0.74 for the strongest single-modality model and 0.68 for language model baselines. For dementia diagnosis, it achieved an AUROC of 0.86, and for survival prediction, a C-index of 0.81. In a reader study with experienced physicians, Cerebra significantly improved expert performance, increasing accuracy by 17.5 percentage points in prospective dementia risk estimation. These results demonstrate Cerebra's potential for interpretable, robust decision support in clinical care.
SafeScreen: A Safety-First Screening Framework for Personalized Video Retrieval for Vulnerable Users
Open-domain video platforms offer rich, personalized content that could support health, caregiving, and educational applications, but their engagement-optimized recommendation algorithms can expose vulnerable users to inappropriate or harmful material. These risks are especially acute in child-directed and care settings (e.g., dementia care), where content must satisfy individualized safety constraints before being shown. We introduce SafeScreen, a safety-first video screening framework that retrieves and presents personalized video while enforcing individualized safety constraints. Rather than ranking videos by relevance or popularity, SafeScreen treats safety as a prerequisite and performs sequential approval or rejection of candidate videos through an automated pipeline. SafeScreen integrates three key components: (i) profile-driven extraction of individualized safety criteria, (ii) evidence-grounded assessments via adaptive question generation and multimodal VideoRAG analysis, and (iii) LLM-based decision-making that verifies safety, appropriateness, and relevance before content exposure. This design enables explainable, real-time screening of uncurated video repositories without relying on precomputed safety labels. We evaluate SafeScreen in a dementia-care reminiscence case study using 30 synthetic patient profiles and 90 test queries. Results demonstrate that SafeScreen prioritizes safety over engagement, diverging from YouTube's engagement-optimized rankings in 80-93% of cases, while maintaining high levels of safety coverage, sensibleness, and groundedness, as validated by both LLM-based evaluation and domain experts.
An Interactive LLM-Based Simulator for Dementia-Related Activities of Daily Living
Effective dementia caregiving requires training and adaptive communication, but assistive AI and robotics are constrained by a lack of context-rich, privacy-sensitive data on how people living with Alzheimer's disease and related dementias (ADRD) behave during activities of daily living (ADLs). We introduce a web-based simulator that uses a large language model (gpt-5-mini) to generate multi-turn, severity- and care-setting-conditioned patient behaviors during ADL assistance, pairing utterances with lightweight behavioral cues (in parentheses). Users set dementia severity, care setting (and time in setting), and ADL; after each patient turn they rate realism (1-5) with optional critique, then respond as the caregiver via free text or by selecting/editing one of four strategy-scaffolded suggestions (Recognition, Negotiation, Facilitation, Validation). We ran an online formative expert-in-the-loop study (14 dementia-care experts, 18 sessions, 112 rated turns). Simulated behavior was judged moderately to highly plausible, with a typical session length of six turns. Experts wrote custom replies for 54.5 percent of turns; Recognition and Facilitation were the most-used suggested strategies. Thematic analysis of critiques produced a six-category failure-mode taxonomy, revealing recurring breakdowns in ADL grounding and care-setting consistency and guiding prompt/workflow refinements. The simulator and logged interactions enable an evidence-driven refinement loop toward validated patient-caregiver co-simulation and support data collection, caregiver training, and assistive AI and robot policy development.