Daily Assistance for Individuals With Dementia via Videophone

Abstract

We previously developed remote reminiscence conversation and schedule prompter systems via the videophone to improve psychological stability and to assist individuals with dementia to perform household tasks. Our results showed that the psychological stability of 1 patient persisted for 3 hours after remote conversations. The task completion rate afforded by the schedule prompter system, which displays a video reminder series automatically, was 52%. In the present study, we also investigated whether psychological stability was sustained in other patients. Furthermore, motivational prompter videos were added to enhance the original schedule prompter system. We found that 1 in 4 patients living at home showed greater stability while conversing with a conversation partner on the videophone than while watching television programs, and that she remained stable for 3 hours after remote conversations. The task completion rate afforded by the revised schedule prompter system was 82%. These 2 remote systems are promising tools for assisting individuals with dementia in their daily lives.

Introduction

The progression of dementia usually begins with mild anterograde amnesia and often involves a variety of behavioral disturbances such as wandering and agitation. ¹ Although neuropathological and neurochemical changes play roles in the development of these cognitive impairments, ² these behavioral disturbances also arise from inactivity, discomfort, and a lack of social contact. ³ To reduce the stress of individuals with dementia and the burden on their caregivers, various therapeutic approaches such as validation and music therapy have been proposed. ^4,5

Reminiscence intervention aims to increase self-esteem and psychosocial well-being ⁶ and to decrease behavioral disturbances. ^5,7 A personalized reminiscence photo video ⁸ uses background music, soothing narration, and panning/zooming effects. Individuals with dementia showed higher concentration while watching the photo videos than while watching television (TV) variety or news shows. ⁸

Recently, several studies have attempted to apply information technologies to support individuals with dementia in their daily lives. The computer interactive reminiscence and conversation aid (CIRCA) project sets a goal of producing a reminiscence experience based on virtual reality that aided the communication between individuals with dementia and their caregivers. ⁹ The COGKNOW project plans to help individuals with dementia remember information, maintain social contact, and perform household tasks. ¹⁰

Communication is a common and enjoyable activity for most people. Individuals with dementia, however, tend to be isolated and poorly informed, with few opportunities to communicate, which is especially true in individuals living at home. ⁸ Therefore, one of the most important interventions for these individuals is to provide opportunities to communicate with people via information and communication technology. Previously, family members’ experiences were investigated during communication via videophones with individuals with dementia who resided in a nursing home. ¹¹ This study’s results showed that people with dementia showed greater focus during conversations via the videophone than during face-to-face conversations. ¹¹

A combination of videophone and reminiscence interventions seems to be more effective for psychological stability. ¹² A remote reminiscence conversation system ¹² that incorporates a videophone with reminiscence photo sharing was created. This system was activated remotely by a conversation partner and in terms of psychological stability; it was effective for individuals living at home. ¹³ Interestingly, 1 patient remained stable for more than 3 hours after the conversation session ended. ¹³ This sustained psychological effect of conversation had not been reported previously. If this effect is confirmed in other patients, remote conversation in advance may prevent arising of behavioral disturbances.

Schedule management is another indispensable intervention in the assistance of individuals with dementia, particularly those living at home. Because of anterograde amnesia, individuals with dementia often forget scheduled tasks such as taking medications and preparing meals. This results in trouble, irritation, and instability. Individuals with dementia who cannot remember scheduled tasks must be reminded constantly by caregivers to perform them. To cope with these problems, integrated chip (IC) recorders have been used for the automatic output of recorded verbal messages. ^14,15

Videophone contact by nursing assistants was effective in reminding individuals with mild dementia to take their medications. ¹⁶ However, in addition to taking medication, there are other household tasks that caregivers hope individuals with dementia can complete independently. It may be difficult for nursing assistants to inform individuals with dementia of all tasks via videophone.

Therefore, a schedule prompter system ¹³ was also developed to help individuals with dementia complete various household tasks. More than 10 types of video reminders were used in the schedule prompter system, as prompting cues for tasks such as taking medicine and preparing meals. An experiment was conducted on 4 patients with dementia living in their homes. The average percentage of completed scheduled household tasks for the 4 patients was approximately 52%. ¹³ Although the results of this study were promising, the average performance of the scheduled tasks was moderate, indicating a need for additional strategies to increase their completion rate.

Individuals with Alzheimer’s disease have cognitive, psychiatric, and behavioral disturbances such as agitation, poor insight, poor motivation, and depressed mood. ¹⁷ The use of a personalized reminiscence photo video improved the concentration of individuals with dementia. ⁸ The automatic output of old music improved their behavior. ¹⁸ In addition, psychomotor exercises have also been suggested to change their mood and behavior. ¹⁹ If these interventions are utilized, the motivation of individuals with dementia may also be sufficiently increased to accomplish scheduled tasks. Therefore, we incorporated a personalized reminiscent photo, ⁸ old music, ¹⁸ and motor exercise ¹⁹ videos as motivational prompter videos to augment the original schedule prompter system. ¹³

In this field study, 2 preliminary experiments were performed using 4 individuals with dementia. Experiment 1 reinvestigated the effects of the remote reminiscence conversation system, including its sustained psychological effect. ¹³ Experiment 2 examined the extent to which this revised schedule prompter system promotes the completion of scheduled tasks.

Methods and Results

Experiment 1: The Remote Reminiscence Conversation System

Patients

The study inclusion criteria for patients were as follows: diagnosed dementia ²⁰ ; normal hearing and vision; the ability to sit and watch the screen of a personal computer (PC) for 40 minutes; agreement with the use of devices and infrastructure, such as a PC, Web camera, and Internet connection via fiber optic cables, in their homes; and agreement by the caregiver to complete an evaluation sheet regarding the patient’s psychological stability and the completion of scheduled household tasks. A total of 4 outpatients of the memory clinic of Chiba Rosai Hospital satisfied these criteria and participated in this experiment as patients. The Mini-Mental State Examination (MMSE) ²¹ was performed to determine dementia severity in each patient. Table 1 shows the profiles of the 4 patients. Although patient 1 had a high score on the MMSE, she was diagnosed with dementia because of the poor scores of a pair words-learning test and story-learning test.

Table 1.

Profiles of the 4 Patients Who Participated in the Study.

Patients	Age	Sex	MMSE	Eti	Behaviors observed by caregivers
1	67	F	29	AD	Asks the same questions repeatedly, does not make meals, looks for keys, forgets newspaper contents
2	78	F	14	AD	Loses her way in the neighborhood, asks the same questions repeatedly, dislikes changing clothes, does not wash hair
3	84	F	19	AD	Asks the same questions repeatedly, forgets to take medicines, buys unnecessary goods repeatedly
4	86	F	16	AD	Dislikes cleaning, loses way in the neighborhood, loses money, forgets to turn off fire

Abbreviations: F, female; Eti, etiology; AD, Alzheimer’s disease; MMSE, Mini-Mental State Examination.

The conversation partner (partner) was a 68-year-old woman who was unfamiliar to the patients. The ethics committee of Chiba Rosai Hospital approved this study.

Materials

A system engineer set up the devices, such as the PC and Web camera, in the home of each patient and of the partner. An HP TouchSmart PC (IQ512jp, 22-inch touch-panel display) with a Web camera was used as the patient’s terminal. A server PC was set up at the Kyoto Institute of Technology. These PCs were connected to the Internet via fiber optic cables. Firefox and Skype were automatically launched when the PCs were switched on. Therefore, caregivers were asked not to turn off or unplug the PC. During the experiment, the system engineer maintained these PCs and their associated systems.

Procedures

To prepare for remote conversation, each patient’s old photos were scanned onto the server PC. The patients, caregivers, and the partner collectively scheduled the 40-minute conversation sessions. The modified ABABAB method was applied to investigate the effects of this system. In session A, the patients were requested to watch TV programs according to their preferences. In session B, the partner remotely booted the patient’s PC (videophone) and asked the patient to sit in front of the PC so that they could have a conversation. The partner was asked to use old photos during the conversations. Sessions A and B were changed on a day-by-day rotating basis. The time and the number of days for A and B sessions were different among the 4 patients (see note in Figure 1). The total period of sessions A and B for the patient lasted for 2 or 3 weeks. Figure 2 illustrates a conversation between a patient and the partner while viewing an old photo of the patient.

Figure 1.

Mean scores of psychological stability as evaluated using the Gottfries–Brane–Steen scale. Lower scores mean more psychological stability. The number of days were as follows: patient 1, 3 days of session A (watching TV programs) and 4 days of session B (remote conversations), at 13:05 to 13:45; patient 3, 6 days of session A and 6 days of session B, at 19:00 to 19:40; patient 4, 8 days of session A and 8 days of session B, at 16:00 to 16:40. A indicates session A; B, session B; Concomitant or Delayed TV, concomitant or delayed evaluation while watching TV programs; Concomitant or Delayed Remote, concomitant or delayed evaluation while conversing remotely.

Figure 2.

Patient talking with the partner while viewing an old photo of herself.

Evaluations

The “Different symptoms common in dementia” section of the Gottfries–Brane–Steen (GBS) scale ²² was used to evaluate psychological stability while the patient watched TV or talked with the partner (concomitant evaluation). Using the dementia section of the GBS scale, ²² the following 6 psychological variables were evaluated: confusion, irritability, anxiety, agony, reduced mood, and restlessness. Each variable was graded on a scale of 0 (most stable) to 6 (least stable). The caregiver observed the patient while the patient was watching TV programs or conversing with the partner. Then, the caregiver graded each of the 6 variables every day in both the sessions. Each scale graded by the caregivers was converted to scores, that is, scale 0 was scored 0, scale 6 was scored 6, and so on. ¹³

The overall psychological stability ¹³ was also evaluated 3 hours after watching TV programs or talking with the partner (delayed evaluation). The caregiver observed the patients’ behavior comprehensively and graded the psychological stability on a scale of 0 to 6 every day in sessions A and B. ¹³ These scales were also converted to the corresponding scores. We also interviewed the caregivers regarding the effects of this remote conversation system.

Results

For measurement of psychological stability, the scores were collected for each patient. These scores were compared between the 2 sessions (A, watching TV programs; and B, remote conversation) and between the 2 evaluations (concomitant and delayed evaluations) for each patient. Figure 1 shows that the mean scores of the patients. Lower scores denote more psychological stability.

The scores of patient 3 in session B (the 2 remote conversation sessions) were low compared with those observed in session A (the 2 TV-watching sessions). A paired t test revealed a significant difference in the scores obtained in the delayed evaluation of these sessions A and B (t (5) = 17.0, P < .01). However, differences were not significant between sessions in the concomitant evaluation (t (5) = 2.46, P > .05). Although greater psychological stability was observed while conversing remotely than while watching TV programs (concomitant evaluation), the significant psychological stability of patient 3 was found 3 hours after the remote conversation ended (delayed evaluation).

The scores obtained for patients 1 and 4 were low in both sessions and evaluations. Moreover, no statistical differences were observed, showing that they were psychologically stable during both the sessions. Patient 2 was almost asleep while watching TV programs, although she did talk with the partner in session B. Consequently, the caregiver of patient 2 did not complete the GBS scoring.

Caregiver’s Observations of the Effects of the Remote Conversation System

Because we could not directly observe the behavior of the patients, the caregivers provided information regarding the effects of remote conversation on patient behavior as follows.

Patient 1: She enjoyed the conversation via the videophone. She talked with the partner as if she was a new friend. Her conversational attitude and tone were not different from those of a face-to-face conversation. She spoke as if she was familiar with remote conversations.

Patient 2: She attends a day care center almost every week day, and that makes her tired. In spite of this, she enjoyed the conversation with the partner, although she was sometimes confused whether the photos on the PC were those of herself or her daughter’s. After the conversation, she became more tired. In contrast, she was almost asleep while watching TV programs. Therefore, the scoring was not completed.

Patient 3: Recently, she has not been able to concentrate on watching TV programs. Regarding the remote conversation, she forgot what she had spoken about with the partner, but she stated repeatedly that it was enjoyable. Her conversational attitude was completely different from that of watching TV programs. A staff at the day care center she attends said “She looks energetic recently.”

Patient 4: She thought that she was not having any disease, and she was busy with household tasks. Thus, if anything, she seemed to be passive about making an effort to talk with the partner. However, old photos showed on the PC served as a good stimulus to remind her of the names of old friends.

Experiment 2: The Schedule Prompter System

Procedures

The patients and materials were the same as those used in experiment 1. The revised schedule prompter system included the following video reminders: navigational prompter (navigational), motivational prompter (motivational), and schedule prompter (scheduler) videos.

The navigational video was 20 seconds in duration and featured beautiful pictures and soothing/nostalgic music. This video was designed to capture the attention of the patient and prompt the patient to move to the PC.

Three types of motivational videos were newly developed (each type of video was approximately 5 minutes in length): (1) old music video ⁸ (3 sets), (2) motor exercise video ¹⁸ (1 set), and (3) reminiscence photo videos of each patient ¹⁹ (3 sets). One type of video was randomly and evenly chosen from the 3 types of motivational videos to ensure the same distribution of these videos. Furthermore, 1 set was also chosen from 3 sets of the old music videos and reminiscence photo videos in the same way. These motivational videos were used to inspire the patient to perform household tasks as directed by the subsequent scheduler videos.

The patients, caregivers, and memory clinic therapist selected household tasks to be performed and their schedule. Consequently, scheduler videos for each household task were also prepared (see Table 2). The length of each scheduler video was approximately 30 seconds. In this video, a memory clinic therapist (or a family member for patient 4) explained the scheduled tasks and reminded the patient to complete them.

Table 2.

The Completion Rates of Different Tasks by the Patients.

	A%	B%	Diff%
Patient 1a
Write diary pm	0	88	88
Write diary am	0	72.2	72.2
Take a walk	18.7	66.6	47.9
Throw garbage	75	100	25
Take medicine pm	70	88	18
Gardening	40	50	10
Take medicine Eve	80	88	8
Washing	100	100	0
Bring in laundry	100	100	0
Check lock	100	100	0
Check against fire	100	100	0
Take medicine am	85	70	−15
Average	64.0	85.2	21.1
Patient 2b
Have teac pm	4	86.6	82.6
Have teac am	0	43.3	43.3
Wash clothes	0	35.7	35.7
Have a bath	50	78.5	23.5
Write diary am	0	12.5	12.5
Close shutters	87.5	96.6	9.1
Open shutters	84	93	9
Clean room	0	0	0
Write diary pm	0	0	0
Write diaryd	0	0	0
Take medicine am	32.6	30	−2.6
Check pressuree	50	43	−7
Take medicined	50	28.5	−21.5
Go to kitchen	71.4	43.7	−27.7
Average, %	30.6	42.2	11.2
Patient 3f
Write diary pm	4.5	100	96.5
Write diaryg	10.7	92.8	82.1
Take medicineg	50	100	50
Take medicineg	53.5	100	46.5
take medicine pm	50	94.4	44.4
Take medicineh	57.1	100	42.9
Prepare supper	57.1	100	42.9
Take medicinei	57.1	95.5	38.4
Wash plates am	67.8	100	32.2
Wash plates pm	71.4	100	28.6
Wash platesg	75	100	25
Prepare lunch box	83.3	100	16.5
Wash clothes	85	100	15
Walk daughterj	100	100	0
Go shopping	100	100	0
Average, %	61.5	98.8	37.4
Patient 4k
Stay at home am	62.5	100	37.5
Stay at home pm	66	100	34.7
Do not go upstairs	100	100	0
Get ready to go out	100	100	0
Take medicine am	100	100	0
Take medicine pm	100	100	0
Take medicine Eve	100	100	0
Average, %	89.7	100	10.3

Abbreviations: A%, A1 and A2 sessions’ accomplished average percentage for each task; B%, B1 and B2 sessions’ accomplished average percentage for each task; Diff%, difference between A% and B%; Eve, evening.

^a The number of days for the sessions A1, B1, B2, A2 were 5, 5, 4, and 5 days, respectively.

^b The number of days for the sessions A1, B1, B2, A2 were 7, 7, 7, and 7 days, respectively.

^c To Buddhist altar.

^d In the evening.

^e Blood pressure.

^f The number of days for the sessions A1, B1, B2, A2 were 7, 7, 8, and 6 days, respectively.

^g After supper.

^h Before supper.

ⁱ Before breakfast.

^j To station.

^k The number of days for the sessions A1, B1, B2, A2 were 7, 7, 7, and 7 days, respectively.

The server automatically delivered the following 2-video reminder series. The original video series (original series) consisted of the navigational and the scheduler videos. The revised video series (revised series) consisted of the navigational, motivational, and scheduler videos. The delivery ratio of the 2-video reminder series was 25% for the original series and 75% for the revised series.

The ABBA method was used in this evaluation. The first week comprised session A1. The caregiver instructed the patient in a typical manner to perform the scheduled tasks. The next 2 weeks comprised sessions B1 and B2. The 2-video reminder series described previously were shown automatically on the PC, after which the patient was required to complete the tasks. The following week comprised session A2. The protocol for session A2 was similar to that used in session A1. The number of days dedicated to each session was different among the 4 patients (see footnotes in Table 2; Figures 3 and 4). The total period of sessions A and B lasted for 4 weeks. Figure 5 depicts the flowchart of experiment 2.

Figure 3.

Average percentages of the scheduled completed tasks for the 4 patients. Note: The number of days for the sessions A1, B1, B2, and A2 were as follows: 5, 5, 4, and 5 days, respectively, for patient 1; 7, 7, 7, and 7 days, respectively, for patient 2; 7, 7, 8, and 6 days, respectively, for patient 3; and 7, 7, 7, and 7 days, respectively, for patient 4. In sessions A1 and A2, the caregiver instructed the patient in a typical manner; in sessions B1 and B2, the 2-video reminder series were shown.

Figure 4.

Average percentages of the completed tasks for the 2 video reminder series. The number of days for session B1 and B2 were as follows: 5 and 4 days, respectively, for patient 1; 7 and 7 days, respectively, for patient 2; 7 and 8 days, respectively, for patient 3; and 7 and 7 days, respectively, for patient 4. Original indicates original video series; Re, revised video series; old music, old music videos; motor exercise, motor exercise video; reminiscence, reminiscence photo videos.

Figure 5.

Flowchart of experiment 2. * indicates 1 of the 3 sets chosen for a task.

Evaluations

The caregiver was required to determine whether the patient completed the scheduled tasks successfully. The contents of the tasks were different among the patients. Therefore, the allotted time in which each task was to be successfully completed was left to the judgment of the caregiver. After each task, the caregiver was requested to check its accomplishment.

The patient received 1 point if the tasks were performed without any additional instructions from the caregiver, 0.5 points if additional instructions were required for the completion of the tasks, and 0 points if the task was not completed, even after additional instructions. ¹³ We also interviewed the caregivers regarding the effects of this system.

Results

Figure 3 shows the results of the completed scheduled tasks. Compared with the average percentages of the scores obtained in session A1 (caregiver instructions), the scores of all patients increased in session B1 (instructions given by the 2-video reminder series). Scores were lower in session A2 than they were in session B2. The average percentage of completed tasks for the 4 patients was 62.6% in the 2 A sessions and 82.9% in the 2 B sessions. The most dramatic increase in scores in the 2 B sessions was observed in patient 3. A paired t test revealed significant differences in the average scores between the A and the B sessions for this patient (t (14) = 5.95, P < .01). No significant differences were found for the remaining 3 patients.

Table 2 shows the average percentage of accomplishment of each household task for the 4 patients. The very low accomplishment in tasks such as “write diary” observed for patients 1 and 3 (Table 2) and “have tea” for patient 2 (Table 2) were improved greatly in session B. However, several 0% completed tasks for patient 2 (Table 2) remained the same in session B. In addition, completion percentages of some tasks were decreased for patient 2 in session B (Table 2).

Figure 4 shows the average percentages of the completed tasks for the 2-video reminder series (original and revised series) in the 2 B sessions. These video series did not yield any significant difference in the completion of tasks by the patients.

Caregiver observations of the effects of the schedule prompter system

The caregivers provided information regarding the effects of the schedule prompter system on patient behavior as follows.

• Patient 1: She did not write her diary. Although she had been advised to write it and knew its importance, it was difficult for her to follow the caregiver’s advice. However, the advice of the therapist in the video was stronger. She began to write the tasks in her diary immediately after she performed each task. However, writing in her diary did not persist when the video was not shown (in the B sessions).

• Patient 2: The PC was set in her bedroom. However, she was often in the kitchen, so the voices from the video were not heard. The timing of video output sometimes did not match her actual activities.

• Patient 3: When the output of the videos started, she complained about feeling as if someone was ordering her to do the task. Nevertheless, she performed the tasks as advised by the videos. Gradually, she accomplished the tasks before the videos instructed her to do so and looked forward to the start of the videos. She even became eager to complete the caregiver’s household tasks. After the videos were stopped, she felt lonely because she could not see the videos anymore. Her completion rate of household tasks decreased, which suggests that she thought performing the tasks was not required anymore.

• Patient 4: She was very glad to see her great grandson appear on the screen and comfortably accepted his advice to “stay home,” because she sometimes lost her way. After the video stopped, she left her home.

Discussion

At institutions, reminiscence therapy is usually conducted in a group led by staff. Therefore, it is difficult to perform at home. On the other hand, remote conversation with volunteers via videophone may be easy to accomplish more frequently. However, the start of videophone conversation requires staff assistance, which may be regarded as an extra burden. ¹¹ Furthermore, there are many household tasks that individuals with dementia forget to complete. The 2 assistance systems described in this study attempted to overcome these difficulties by providing remote reminiscence conversation with a partner and automatic output of schedule prompter videos for individuals with dementia living in their homes.

Experiment 1: The Remote Reminiscence Conversation System

The results of this experiment revealed that remote conversation was effective in 1 of the 4 patients. The mean psychological stability of patient 3, as evaluated using the GBS scale, ²² was more explicit while conversing remotely than while watching TV programs. According to the caregiver, she had difficulty in watching TV programs and often exhibited restless behavior in the evening. However, she seemed to enjoy the remote conversation with the partner, leading to dramatic increases in psychological stability.

Furthermore, the increased stability of patient 3 was statistically significant in the delayed evaluation, which was performed 3 hours after the remote conversation ended. In our previous study, ¹³ 1 patient also had difficulty in watching TV programs and restless behavior in the evening. However, enjoyment of the remote conversation resulted in an increase in psychological stability, which was also sustained for 3 hours. ¹³

Sustained psychological effects of music ¹⁷ and video biographies ²³ in individuals with dementia have been reported. Communicating with a partner may have reduced the stress of patient 3, and this stress-reduced state may have persisted for 3 hours. This result agrees with the hypotheses that behavioral disturbances arise from a lack of social contact ³ and that reminiscence interventions decrease these disturbances. ^{5 –7}

Although patient 3 was the second case to exhibit this phenomenon, it is suggested that the conversation itself has the potential to prevent individuals with dementia from showing anticipated behavioral disturbances such as “evening syndrome.” However, it is very difficult for individuals with dementia to engage in frequent and regular face-to-face conversations. In contrast, remote conversation with volunteers via videophone may be easier. This stability may ease the burden of the caregiver.

The caregivers of patients 1 and 2 observed that they enjoyed talking with the partner. They also enjoyed watching TV programs, which explains why remote conversation had no significant effect on their psychological stability. Regarding the effectiveness of this system, further studies should focus on patients who exhibit restless behaviors but are able to enjoy the conversation.

Although conversation with the partner prevented patient 2 from falling asleep, the caregiver’s observation of this patient indicates that to avoid fatigue, the timing and duration of the conversation should have been planned more carefully.

The conversation partner had to lead the videophone talking, which is perceived as demanding. ¹¹ As dementia progresses, it becomes increasingly difficult to find topics of conversation. For this purpose, we have developed several electronic and remote conversation assistance systems. ^24,25

Experiment 2: The Schedule Prompter System

The ability of patient 3 to complete her household tasks was significantly improved by this system, to the point that she became eager to assist in the completion of her caregiver’s tasks. She appeared to gain self-esteem because of this system. Patient 4 obeyed the video instruction to “stay home.” However, immediately after the video stopped, she went out of her house, which could have resulted in her getting lost. Her caregiver asked us to continue to use this system after the experiment. Therefore, this system remains in use for patient 4. These results supported the argument that the automatic output of the scheduler videos worked more effectively than the typical instructions given by the caregiver. ¹³

In this study, motivational prompter videos were added to the original schedule prompter system. ¹³ The average percentage of completed tasks for the 4 patients was 82.9% in the 2 B sessions (instructions provided by the revised system), compared with 52% observed in a previous study. ¹³ Although the patients were different from those who participated in the previous study, ¹³ the revised schedule prompter system may have improved their concentration, ⁸ behavior, ¹⁸ and mood, ¹⁹ and may have succeeded in motivating patients to accomplish the scheduled household tasks.

Furthermore, as the instructions are usually given by their caregivers, the instruction from the videos may have had a fresh impact on the patients. ¹⁵ An individual with dementia bowed his head very politely to the recorded instruction of his therapist by an IC recorder, saying “you are very kind to assist me.” ¹⁵ In this way, the attitude of maintaining social relationships was usually preserved in individuals with mild or moderate dementia. ¹⁵ Therefore, they tended to obey instructions from “social resources” such as therapists and doctors more frequently than they obeyed those of the caregivers. The superiority of the effect of the videos in the 2 B sessions can also be explained by this hypothesis as well as the increased motivations discussed previously.

The completion rates of tasks that were associated with poor success rates in session A, such as “write diary” for patients 1 and 3, tended to increase in session B. In contrast, the accomplished percentages of some tasks by patient 2 remained the same or decreased in session B. Judging from the caregiver’s observation of this patient, the placement of the PC and the timetable of the video output may have been inappropriate in this case. Therefore, speedy adjustment is important for the effective use of these videos. The household tasks performed in experiment 2 were different among the 4 patients, which hampered further analysis of the results. In future, the detailed case reports will reveal conditions in which household tasks are effectively executed according to this system.

A differential effectiveness of the 2-video reminder series in the 2 B sessions was not observed in the 4 patients. The main reasons for this result may be the failure of the experimental design. During the 2-week B sessions, the order of these videos changed, and the videos were repeated throughout the day. Because of the sustained psychological effects of music ¹⁷ and video biographies, ²³ the effects of each motivational prompter video may have been intermixed with those of other videos. The results may have been different if 1 type of video was viewed during a certain session before introducing another video. To evaluate the individual effects of these videos, alternative experimental designs will be needed.

Conclusions

In this preliminary field study, most of the tasks were performed outside the range of the Web camera, such as watching TV programs in experiment 1 and gardening and having a bath in experiment 2. It was quite difficult to record these behaviors to obtain reliable data. These 2 experiments also exhibited procedural differences among the patients, such as the number of days, contents of household tasks, and so on. Although these procedural limitations and the small number of patients participated require cautious interpretation of the results, the remote reminiscence conversation system and the revised schedule prompter system showed potential to support psychological stability and schedule completion in individuals with dementia.