Embodied Conversational Agents for Patients With Dementia: Thematic Literature Analysis

Abstract

Background As the world’s population rapidly ages, the number of older adults with cognitive impairment will also increase. Several studies have identified numerous complex needs of people with dementia, which assistive technologies still fail to support. Recent trends have led to an increasing focus on the use of embodied conversational agents (ECAs) as virtual entities able to interact with a person through natural and familiar verbal and nonverbal communication. The use of ECAs could improve the accessibility and acceptance of assistive technologies matching those high-level needs that are not well covered to date. Objective The aim of this thematic literature analysis was to map current studies in the field of designing ECAs for patients with dementia in order to identify the existing research trend and possible gaps that need to be covered in the near future. The review questions in this study were as follows: (1) what research frameworks are used to study the interaction between patients with dementia and ECAs? (2) what are the findings? and (3) what are the barriers reported in these studies? Methods Separate literature searches were conducted in PubMed, Web of Science, Scopus, and Embase databases by using specific umbrella phrases to target the population (patients with dementia) and the technology-based intervention (embodied conversational agent). Studies that met the inclusion criteria were appraised through the Mixed Methods Appraisal Tool and then discussed in a thematic analysis. Results The search process identified 115 records from the databases and study references. After duplicates (n=45) were removed, 70 papers remained for the initial screening. A total of 7 studies were finally included in the qualitative synthesis. A thematic analysis of the reviewed studies identified major themes and subthemes: the research frameworks used to gather users’ perspectives on ECAs (theme 1), the insights shared by the 7 studies as well as the value of user involvement in the development phases and the challenge of matching the system functionalities with the users’ needs (theme 2), and the main methodological and technical problems faced by each study team (theme 3). Conclusions Our thematic literature analysis shows that the field of ECAs is novel and poorly discussed in the scientific community and that more sophisticated study designs and proofs of efficacy of the approach are required. Therefore, by analyzing the main topic of the narrative review, this study underscores the challenge of synchronizing and harmonizing knowledge, efforts, and challenges in the dementia care field and its person-centered paradigm through the user-centered design approach. Enabling strict collaboration between interdisciplinary research networks, medical scientists, technology developers, patients, and their formal and informal caregivers is still a great challenge in the field of technologies for older adults.

Toward the Integration of Technology-Based Interventions in the Care Pathway for People with Dementia: A Cross-National Study

“…As aforementioned, in the majority of the cases, the main problem presented at first contact with the health care system is related to memory issues [ 31 , 32 ] and, especially, at this first stage, individuals are experiencing uncertainty, confusion, anxiety, worrying about memory problems, and future life [ 33 ]. Since the definition of clinical care pathways for dementia starts at this point, it could be strategic to introduce technologies at this early stage to guarantee familiarity [ 8 ] with new devices and assure the acquisition or improvement of digital competencies since perceived difficulties become more pronounced as dementia severity increases [ 34 , 35 , 36 ]. For example, the telemetry data reported in this study underlined how a period of familiarization is necessary to switch from an exploratory usage to an advanced one.…”

“…Moreover, the interaction modality through the voice is the most natural and easy way to communicate, especially for people with dementia in the middle stage [ 8 ]. Despite this advantage, personalization remains a critical challenge.…”

“…In comparison with other ECAs designed for people with dementia, this virtual agent represents a step forward: (1) Anne is based on a mobile standalone solution, whereas the other examples of virtual agents are displayed on standard television sets and computer screens; (2) Anne offers a multipurpose tool integrating features such as reminders (personal and medication agenda), communication (video calls), information (news), and entertainment (games and music) that support users in all aspects of daily life engaging them in various activities (i.e., help them pass the time in a more meaningful way and improve their quality of life). On the contrary, other ECA functions sought mainly to overcome memory problems, guide patients in their daily activities, and meet their need for communication and social interaction [ 8 ].…”

“…Significant optimism has recently emerged with the use of screen-based entities designed to encourage human face-to-face conversation skills [ 6 ]. Such virtual entities, called embodied conversational agents (ECAs) or personal virtual assistants (PVAs) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ], are natural, personalized, and human-like 2D and 3D chatbots or wholly embodied conversational agents acting in ambient-assisted living environments [ 16 , 17 ]. Due to this human resemblance, this technology reached the attention of the health sector, especially in the area of health counseling, coaching, and self-monitoring [ 18 ].…”

“…This lack of evidence is due to the substantial difficulties in researching within this field. Indeed, involving individuals with dementia, and the possibility of engaging them in using new technologies for a significant period, is a common limitation that impacts the generalization of results [ 8 ]. Moreover, these individuals have often low digital experience and decreasing abilities in managing routine changes (i.e., introducing a new device into their daily life) along the path defined by the progression of symptoms.…”