Advances in technology are broadening treatment options for patients with major neurocognitive dysfunction.
A pilot study has found that a “social robot” may improve neuropsychiatric symptoms in patients with major neurocognitive dysfunction associated with dementia.1 “This study shows that a brief intervention using Paro® without the simultaneous physical presence of a health care provider appears to improve the psychological well-being in patients with major neurocognitive dysfunction,” wrote senior author Victoria Cristancho-Lacroix, MSc, PhD, of Greater Paris University Hospitals, (Paris, France) and colleagues.
“Interestingly, analysis also revealed a differential effect depending on the neuropsychiatric profile. The intervention reduced the negative affect of agitated patients more significantly than those of depressed patients,” they added.
About 90% of people with dementia suffer from behavioral and psychological symptoms, the most frequent of which is apathy, followed by depressive symptoms, agitation, irritability, and anxiety. Behavioral symptoms increase the risk of hospitalization, nursing home placement, and provider and caretaker burden.
International guidelines recommend nonpharmacological therapy as first line treatment for the behavioral and psychological symptoms of dementia. Social robots have been proposed as one treatment method.
The Paro® robot (Intelligent System Co., Kyoto, Japan) is modeled after a baby harp seal and is covered with artificial white hair. Weighing about six pounds, the robot may have effects similar to traditional pets, without hygiene and safety issues. Like a dog, Paro® reacts by moving or making sounds in response to most physical interactions, such as touch, eye contact, and verbal communication.
To see how Paro® might affect the emotional well-being of patients with major neurocognitive dysfunction, researchers conducted a pilot study in a geriatric hospital in Paris between January and June 2017. The study included 17 patients with major neurocognitive dysfunction with apathy (n=6), depression (n=7), and agitation (n=4). Most (80%) were women with a mean age of 83.
The intervention used a pre-defined protocol and was designed for a real-world setting with limited resources. It consisted of two weekly 15-minute sessions over four weeks. Sessions were kept as short as possible to minimize provider burden. Each participant was left alone with the robot. Providers left the room but were easily accessible when needed. Sessions were videotaped for qualitative analysis.
Researchers evaluated emotional well-being before and after the intervention using the International Positive and Negative Affect Schedule Short-form (I-PANAS SF). They also assessed cognitive status and neuropsychiatric symptoms (apathy, depression, anxiety) using commonly used, standardized instruments. Seventy-six percent of participants completed all four sessions.
• Overall significant increase in positive affect (p=0.02)
• No impact on negative affect (p=0.19)
• Subgroup analysis:
Negative affect significantly improved in agitated vs depressed patients (p=0.03)
No significant differences between the apathetic group vs depressed or agitated groups
• Participants rated Paro® as highly usable BUT acceptability may be an issue:
60% rated Paro® as childlike
67% rated Paro® as stigmatizing
The qualitative analysis suggested that the device may stimulate positive affect. While videotaped, most patients expressed positive verbal or nonverbal affective behavior towards Paro®, such as caressing, smiling, and hugging the robot. Almost 30% mentioned that Paro had triggered positive or negative memories.
One patient had nightmares after the session and was discontinued from the study. Researchers suggested that patient history should be considered when selecting which patients may benefit from the robot.
The study was small, and larger, longer-term studies that include a control group are needed to confirm results. Further studies should also evaluate whether men have similar responses as women. And, they should include individuals with severe neurocognitive dysfunction. These patients were excluded from this study because I-PANAS required participants who could understand questions and respond coherently.
“These results have paved the way for further research into short Paro® robot exposure in patients with major neurocognitive dysfunction with neuropsychiatric problems,” the authors concluded.
Take home points
• Short sessions were linked to overall improved positive affect in dementia
• Agitated patients showed significantly better improvement in negative affect compared with depressed patients
• Qualitative analysis suggested Paro® may stimulate positive affect and memories
• The Paro® robot was rated as highly usable, but acceptability may be an issue
1. Demange M, Lenoir H, Pino M, et al. Improving well-being in patients with major neurodegenerative disorders: differential efficacy of brief social robot-based intervention for 3 neuropsychiatric profiles. Clin Interv Aging. 2018;13:1303-1311.
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