Home-Based Cognitively Assistive Robots: Maximizing Cognitive Functioning and Maintaining Independence in Older Adults Without Dementia

Figures & data

Table 1 Promising CAR Studies

Authors	Robot	Robot Hardware/Software	Research Design	Cognitive Intervention	Outcomes/Results	Strengths/Limitations
Tanaka et al, 2012^Citation74	Kabochan Nodding Communication ROBOT	Both robots: 28cm and 680g. Communication robot: Morphology and communication resemble a 3-year-old boy. Included affective behavior and interacted by talking and nodding. Control robot: same morphology but did not communicate.	Randomized controlled trial: 34 healthy, independently-living older adult Japanese women were randomized to reside with either a communication robot (n = 18) or a control robot (n = 16) for 8 weeks. Assessments conducted at baseline, 4 weeks, and 8 weeks.	Daily communications with the robot.	Cognitive: Paper-pencil screening instrument and brief computer-based measure of attention, naming, verbal abstraction, judgment, comprehension, repetition, visuoconstruction, verbal memory, calculation, and orientation. Self-report: Standardized, validated measures of activities of daily living, depression, sleep, and appetite. Physiological: Cortisol and autonomic activation. Results: Sleep improved, cortisol decreased, and overall cognition, judgment, and verbal memory improved in the intervention but not the control group.	Strengths: Medium-sized sample; use of an experimental design and a control group; neuropsychological outcome measures; significant cognitive results. Limitations: Did not report on details of the intervention (e.g., number/type of daily communications in the experimental group); generalizability limited to women.
Anh et al, 2014^Citation84	iRobiS	45x32x32cm, 7kg. Intel Atom processor-based internal computer. Includes two arms, physical touch sensors, and a 7in touch screen.	Non-experimental design: 10 independently living older adults in New Zealand. Participants completed four brain training games based on paper-based exercises developed by a psychologist and a teacher.	Four brain training exercises developed for the current study. Cognitive domains targeted: working memory, verbal memory, non-verbal memory, short-term memory, face recognition, and prospective memory.	Self-report usability questionnaire: The tasks were reported to be high in usability, interest, and enjoyment and low in consistency across tasks. Task completion: Tasks were “passed” (sufficient performance to complete a level) at different rates, with one task being deemed too difficult.	Strengths: Focused on computer-based cognitive training; recruited independently-living older adults; usability, interest, and enjoyment of the treatment were high. Limitations: Small, unrepresentative sample; non- experimental design with no control group, no theory-based or empirically-based cognitive intervention, no standardized, validated neuropsychological outcomes.
Broadbent et al, 2014^Citation79	1. iRobiQ 2. Cafero	iRobiQ: 45x32x32cm, 7kg. Includes 7in touch screen, microphone, camera, speakers, and a face. Head, arms, and base move. Includes medication management software. Cafero: 4ft tall. Includes touchscreen, microphone, camera, speakers, and Skype calling. Also includes Dakim Brain Fitness software and calendar reminders.	Repeated measures randomized controlled cross-over trial: 29 older adults in a retirement village in New Zealand. Participants used robots in their apartments for 6 weeks and experienced a 6-week non-robot control in a randomized order. Assessments conducted at baseline, 6 weeks, and 12 weeks.	Both robots took blood pressure and pulse oximetry and produced music. iRobiQ assistant with medication adherence. Cafero provided cognitive training via Dakim Brain Fitness (http://www.dakim.com/), electronic calendar reminders, and allowed for Skype calls.	Outcome measures: Acceptability and feasibility of the robots assessed via unstructured interviews, questionnaires, and diaries. Health-related quality of life, depression, and medication adherence assessed via standardized, empirically-supported measures. Results: Reactions to the robots were mixed. No significant differences reported in quality of life, depression, or medication adherence.	Strengths: In-home design; experimental methodology; multicomponent intervention; standardized, empirically-supported outcome measures. Limitations: Small sample size; used two different robots with different capabilities; no neuropsychological outcome measures; no measurable impact of the intervention.
Kim et al, 2015^Citation80	1. Silbot 2. Mero	No details provided.	Randomized controlled trial: 85 healthy older adults in South Korea randomized to cognitive training (n = 48; traditional cognitive training = 24, robot cognitive training = 24) or no training (n = 37). Training consisted of 90-minute sessions once per day, five days a week, for twelve weeks total (60 sessions). Assessments conducted at baseline and post-intervention.	All participants completed 10 hours of dementia education. Both cognitive intervention groups underwent 2 training blocks targeting five domains: memory, language, calculation, visuospatial function, and executive functions. Two psychometricians assisted both groups. The cognitive intervention was designed by internally-based neurologists, neuropsychologists, and speech-language pathologists.	Magnetic resonance imaging: Changes in cortical thickness and structural brain networks. Neuropsychological measures: Standardized, validated neuropsychological measures of overall cognition, visual memory, working memory, executive functions, and attention. Results: Relative to the control group, both cognitive training groups showed less cortical thinning in frontotemporal association cortices. Relative to the traditional training group, the robot group showed less cortical thinning in the anterior cingulate cortex. The training group improved more on executive functions than the control group. General cognitive ability and visual memory improved more in the traditional training group than the robot training group.	Strengths: Large sample size; use of an experimental design and a control group; high dose of the cognitive intervention; standardized neuropsychological outcomes. Limitations: Robot hardware/software not detailed; no in-home measurement; no empirical support provided for the cognitive intervention used; no results supporting the utility of the robot in cognitive training.
Otake-Matsuura et al, 2019^Citation81	Bono	A “chair-robot” adept at time management and turn-taking moderation based on analysis of speech patterns. Capabilities facilitating a moderator role include head pitching, body rotation, left/right arm elevations, and audio prompting.	Randomized controlled trial: 65 community-living, non-demented Japanese older adults were randomized to either receive the Photo-Integrated Conversation (PICMOR) intervention delivered by the robot (n = 32) or an unstructured group conversation (n = 33) for 12 weeks. Conversations took place in groups of 4–5 participants for 60 minutes. Outcome assessments were conducted at baseline and immediately post-intervention.	The PICMOR intervention targeted preparation of conversation topics (e.g., “Favorite Food”), time management, turn-taking in conversations, and reflection on the topics using a group conversation support method (Coimagination) and a moderator robot. PICMOR included preparation, conversation, and reflection. The robot managed turn-taking by moderating the amount of time each participant spent speaking.	Neuropsychological measures: Standardized, valid neuropsychological measures of global cognition, attention, processing speed, language, and executive functions. Self-report: Physical and mental health status and quality of life. Process outcome measures: Conversational speech characteristics and memory for conversation topics. Results: Verbal fluency, improved in the intervention compared to the control group. Diversity of conversational speech was greater in the intervention compared to the control group.	Strengths: Medium-sized sample; use of an experimental design and a control group; multiple neuropsychological and linguistic outcome measures; significant cognitive and conversational results. Limitations: No follow-up outcome assessment; infrequent (1/week) study sessions; a lack of a non-conversation control condition; and a lack of a structured, moderated, non-robot control condition (so it is unclear whether structure or the robot explain group differences).
Sawami et al, 2019^Citation82	Conversation and dance-therapy robots (no name provided)	Communication robots that primarily intervened through conversation and cognitive dance therapy. No other details provided.	Pre-post, single-group design: 71 older adult non-demented Japanese participants completed 90 minutes of cognitive dance therapy once per week for 7 weeks. Outcome assessments were conducted at baseline and immediately post-intervention.	Participants attempted to learn ten words, practiced a choreography routine, recalled the ten words, recreated the choreography routine, danced and sang simultaneously, and then recalled song lyrics. Participants were able to support each other while completing the memory tasks.	Neuropsychological measures: Cognitive evaluation scale for National Police Agency of driver’s licenses (orientation, visuoconstruction, memory). Self-report: Four items measuring comfort, satisfaction, stress, and vitality. Results: Objective cognitive performance significantly improved after cognitive dance therapy. There was also significant improvement in self-reported mood, satisfaction, and vitality. A correlation was found between cognitive functioning and mental state.	Strengths: Medium-sized sample; significant pre-post improvements in cognitive and self-report measures. Limitations: Non-experimental design with no control group; brief intervention; lack of standardized, validated, objective neuropsychological outcome measures; brief overall outcome assessment, no follow-up evaluation.

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