Chatbots for Dementia Patients and Caregivers Need More Work

Chatbots hold promise for dementia patient or caregiver support, but are still in their infancy, finds a paper published in the Journal of Medical Internet Research.

None of the interactive digital apps tested by medical researchers and a computer scientist performed well on all testing criteria, and all the apps contained linguistic biases and usability challenges. The authors conclude that until developers produce evidence-based chatbots that have undergone end user evaluation it will be hard to evaluate their potential to adequately educate and support dementia patients and their caregivers.

“Dementia care is complex and no two cases of dementia are alike,” said first author Dr. Nicole Ruggiano, a professor of social work at The University of Alabama. “Chatbots have the potential of providing caregivers with instant support that is evidence-based and personalized. While it was promising to find some advancements in this area, it was disappointing to learn that more hasn’t been done.”

Chatbots have become a familiar presence in online customer service settings, and millions of people use personal digital assistants like Amazon’s Alexa or Apple’s Siri to perform tasks and retrieve information every day. Chatbots combine text or voice recognition, machine learning, and pre-programmed responses to afford users relatively seamless conversation with a human-like machine.

Healthcare chatbots can interpret symptoms, suggest resources, or offer emotional support. They have potential to improve the communication between increasing dementia patients, their caregivers and the healthcare system, said corresponding author Dr. Vagelis Hristidis, a professor of computer science at the University of California, Riverside.

Chatbots can provide memory training or stimulate fond recollections for dementia patients. Dementia patient caregivers, who often feel isolated and insufficient, can receive advice and emotional support from chatbots. The effectiveness of chatbot interventions, however, is only as good as the medical knowledge used in their programming and the quality of the user’s interactions with the bot.

To assess the potential for chatbots to assist with dementia care, a team of researchers from UA, Florida International University, and UC Riverside identified six chatbot apps that fit all evaluation criteria. The authors assessed the productivity, effectiveness, functionality and humanity, and overall satisfaction, including affect, ethics and behavior.

The apps were generally focused on the epidemiology and symptoms of dementia and less on caregiving skills and activities. It was difficult to start using all the apps, which would present a big hurdle for people without experience using computers or for people with dementia. The voice chatbot apps only responded to specific pronunciations and vocabulary terms, limiting their use to certain speech styles and dialects. All six of the apps were only available in English, further limiting their usefulness.

However, once the researchers were able to get the programs started, they worked well. Of the five chatbots designed to educate about dementia, three had a breadth of knowledge and flexibility in interpreting information. Users were able to interact with the apps in a human-like way.

In general, the apps’ limited program content made it hard to have extended or varied conversations between users and chatbots. Because dementia is complex and the symptoms varied, this could limit the education and support the apps provide. It also was unclear if information programmed into the apps came from evidence-based medical literature or professional practice, or more questionable Internet sources.

Along Ruggiano, Dr. Ellen Brown, Erica Wertheim Zohar Endowed Chair in Community Mental Health at Florida International University, is co-first author. Other co-authors include Yan Luo and Zhichao Hao at UA and Lisa Roberts and Victoria Framil Suarez at Florida International.

This story is modified from the original published by UC Riverside.