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

TL;DR

This paper presents a web-based simulator using a large language model to generate realistic dementia patient behaviors during daily activities, aiding caregiver training and AI development.

Contribution

It introduces an interactive, customizable simulator for dementia care scenarios, with expert-in-the-loop evaluation and a taxonomy of failure modes for refinement.

Findings

Simulated behaviors were rated moderately to highly plausible by experts.

Caregivers frequently used recognition and facilitation strategies in responses.

The system enables iterative refinement and supports AI and robot policy development.

Abstract

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.