Analysis of interaction patterns from robot-delivered individual CST (iCST) sessions conducted with people living with dementia in home settings provides empirical insights into the factors that shape conversational engagement in robot-delivered iCST, which inform the design of adaptive conversational robots for dementia therapy.
Abstract
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.
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 ($7$ 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.
Individual Cognitive Stimulation Therapy (iCST) is a home-based psychosocial intervention for persons living with dementia (PLwDs) whose therapeutic value depends not only on activity content but also on how the session is conducted. Existing digital and voice-based iCST systems can still feel staged, especially around pauses, restarts, and slow endings. We describe a browser-based research prototype that uses continuous, interruptible speech to deliver a short iCST session. A central design move in the prototype is to separate local turn-taking from session-level control: the underlying real-time API manages interruption and exchange timing, while the application manages overall session progression. We describe how a prior formative study, iCST guidance, dementia communication literature, and iterative implementation informed the session arc, the system boundary, and the role-and-prompt structure. We conclude by discussing the design implications, limitations, and future evaluation needs for conducting an iCST session with a real-time voice agent.
Yixiao Li, Ita Daryanti Saragih, Donna M. Fick et al.· International Conference on...· 0 citations
A LINE-deployed conversational AI system grounded in the WHO iSupport for Dementia framework, built around an Assessment-Before-Intervention dialogue mechanism, which offers practical implications for the design of AI-assisted care systems in dementia and other emotionally sensitive healthcare contexts.
Background and Purpose: Dementia communication is commonly understood as a consequence of progressive cognitive decline. However, growing evidence suggests that meaningful interaction can persist despite substantial impairment, raising questions about the factors that facilitate conversational engagement in everyday care settings. Existing research has largely focused on Euro-American contexts and has paid limited attention to how communication is shaped by cultural, emotional, and relational processes within Southeast Asian caregiving environments. This study investigates how conversational continuity, emotional tone, and thematic relevance influence interactions between caregivers and older adults with dementia (OAD) in Malaysia.
Methodology: A qualitative descriptive design informed by a pragmatic epistemological framework was employed. Data were collected from 42 caregivers across institutional and home-based care settings in Malaysia through a two-week focused observation phase followed by semi-structured interviews. The data were analysed using reflexive thematic analysis.
Findings: Eight interrelated themes were identified that illuminate how conversational continuity, emotional engagement, nonverbal communication, reminiscence, communicative disruption, and meaning negotiation shape interactions between caregivers and OAD. These findings challenge deficit-oriented accounts of dementia communication by demonstrating that conversational continuity is not solely determined by cognitive capacity but emerges through the interplay of thematic familiarity, emotional regulation, caregiver responsiveness, and culturally embedded practices. Familiar topics, positive emotional states, reminiscence, and nonverbal sensitivity emerged as key facilitators of meaningful engagement, while repetition, topic shifts, and misunderstanding presented recurring interactional challenges.
Contributions: The study advances interactional understandings of dementia communication by demonstrating how communicative participation emerges through the interplay of cognitive, affective, and sociocultural resources. Empirically, it contributes evidence from an underrepresented Southeast Asian context, while practically informing culturally responsive caregiver training and person-centred dementia care.
Keywords: Dementia communication, conversational continuity, caregiving, mood regulation, reminiscence, person-centred care, Southeast Asia.
Cite as: Ismail, R., Asyraf, N. W., Alias, N. D. F., Mohd Nor, M., & Husain, S. (2026). Conversation dynamics: Continuity, mood, and topics in interactions with older adults with dementia. Journal of Nusantara Studies, 11(2), 148-167. http://dx.doi.org/10.24200/jonus.vol11iss2pp148-167
Radhiah Ismail, N. Asyraf, Noor Durrah Farahi Alias et al.· Journal of Nusantara Studies...· 0 citations
OBJECTIVES
A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes.
METHODS
Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority).
RESULTS
iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers' perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers' resonance with metaphors and case examples, and by their engagement with intervention content (e.g. note-taking) and therapists (e.g. therapeutic relationships).
CONCLUSION
iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.
Abbey Couchman, T. Katangwe-Chigamba, David Howe et al.· Aging & Mental Health· 0 citations
Social robots have been widely explored as tools for autism intervention, yet this literature has focused predominantly on children and has rarely involved autistic adults as active contributors to design. This creates a mismatch between existing systems and the social-cognitive challenges autistic adults actually face in everyday life, including navigating ambiguous interpersonal contexts, managing conversational timing, and interpreting implied emotional meaning. To address this gap, we conducted an online focus group and co-design session with five autistic adults to explore what a social robot for social-cognition training should do, how it should interact, and under what conditions it would be genuinely useful. The 90-minute session combined open discussion with structured co-design activities on a shared digital whiteboard, and the resulting verbal and visual data were analysed using reflexive thematic analysis. The analysis yielded seven themes that define core design requirements: the robot should function as a scaffold rather than a substitute, prioritise authenticity over comfort, provide personalised and user-controlled feedback, accommodate emotional self-awareness gaps, respect privacy and contextual boundaries, support rehearsal for real-world social situations, and remain configurable in identity, form, and expression. Together, the findings suggest that autistic adults envision the robot not as a companion or live social assistant, but as a private, configurable rehearsal partner designed to support independence over time.
Yuval Zohar, Mordi Benhamou, Guy Laban· 0 citations