Characteristics of selected studies
| Role | Ref. | Participants | Setting | Intervention/study design | Duration | Measures | Outcome |
| Affective therapy | Gustafsson et al 34 | Four subjects (two men) aged 82–90 years, with dementia | Dementia care home, Sweden | Supervised one-on-one interaction with JustoCat. Pilot study. | One session (unknown time length)/week for 7 weeks. | QUALID, CMAI and interview | 1. No significant changes observed in scales |
| Takayanagi et al 22 | 30 subjects (19 with mild/moderate dementia+11 with severe dementia), mean age 84.9 years (mild/moderate), 87.5 years (severe) | Nursing care facility, resident’s room, Japan | Supervised one-on-one interaction with Paro and Stuffed Lion. Pilot study. | One session (~15 min) for each intervention per subject, separated by 3–6 months | Observed behaviour seen in video-recording |
In both groups: 1. Subjects talked more frequently to PARO (P<0.05). 2. Showed more positive emotional expressions with PARO (P<0.01). In mild/moderate group only: 1. Showed more negative emotional expressions with Lion. 2. Frequencies of touching and stroking and frequencies of talking to staff member were higher with Lion. In severe group only: 1. Showed neutral expression more frequently with Lion. | |
| Bemelmans et al 20 | 71 subjects (14 men) with dementia in two groups: therapeutic intervention and care support intervention | Psychogeriatric care institutions, The Netherlands | Supervised one-on-one interaction with Paro or no intervention. Paro either served as a therapeutic or a care support tool in two separate phases of the study. Crossover study. | Five sessions (~15 min)/month for 2 months; each month of therapy was interspersed with a control month. In the therapeutic arm only, additional sessions were given when patient was in distress. | IPPA and Coop/Wonca after each interaction | 1. Therapeutic-related interventions show an increase of IPPA scores by two points (P<0.01). 2. Care support intervention showed no effect. | |
| Jøranson et al 35 36 | 53 subjects (20 men) aged 62–95, with a cognitive impairment (MMSE <25) or diagnosed dementia | Nursing home, separate room, Norway | Supervised group interaction with Paro or TAU. Randomised controlled trial. | Two sessions (~30 min)/week for 12 weeks | Cognitive status, medication, BARS, Norwegian version of CSDD called CDR, QUALID assessed before (T0), after (T1) and at 3-month follow-up (T2) | 1. Reduction in agitation in Paro versus TAU from T0 to T2 (P<0.05). 2. Reduction in depression in Paro versus TAU from T0 to T2 (P<0.05). 3. In those with severe dementia, quality of life scores did not decrease in Paro group from T0 to T2, whereas they did in control. 4. No such difference was found in mild to moderate dementia group. | |
| Moyle et al 37 | 18 subjects, aged >65 years, with dementia | Nursing home, Australia | Supervised group interaction with Paro or reading group. Randomised controlled trial. | Three sessions (~45 min)/week for 5 weeks | Modified QoLAD, RAID, AES, GDS, Revised Algase Wandering Scale–Nursing Home version and OERS | 1. The Paro group had higher QoLAD and OERS-Pleasure scores following the intervention. 2. The Paro group had reduced OERS-Anxiety and OERS-Sadness scores following intervention. | |
| Wada et al 38–45 | 14 subjects (all female) aged 77–98 years, one subject without dementia | Health service facility, Japan | Free group interaction with Paro. Pilot study. | Two sessions (1 hour)/week for 1 year (and a 5-year follow-up) | Face scale, GDS and nursing comments | 1. A tendency to improve depression after 8 weeks. 2. Improvement in mood. 3. Patients did not lose their interest in the long term. | |
| Thodberg et al 13 46 47 | 100 subjects with a mean age of 85.5 years | Nursing homes, Denmark | Supervised one-on-one interaction with Paro, dog or toy cat. Randomised controlled trial. | Two sessions (10 min)/week for 6 weeks | MMSE, GBS, GDS, CAM, sleep data and BMI | 1. Greater interaction with Paro and dog compared with toy. 2. Cognitive and independence scores worsened over study period in all groups (P<0.05). 3. Depression scores improved over study in all group (P<0.05). | |
| Libin and Cohen-Mansfield23 | Nine subjects (all female) aged 83–98 years, with dementia | Nursing home, USA | Supervised one-on-one interaction with NeCoRo and toy cat. Crossover study. | One session (10 min) for each intervention | ABMI, LMBS and observations | 1. Both cats maintained participant’s interest. 2. Significant increase in pleasure (P<0.01) and interest (P<0.05) scores while playing with NeCoRo. 3. Only the toy cat improved agitation scores (P<0.05). | |
| Wada et al 14 48 49 | 26 subjects (all female) aged 73–93 years, some subjects had dementia | Day service centre, Japan | Free group interaction with Paro. Pilot study. | Three sessions (~45 min)/week for 5 weeks | Summarised POMS, burnout scale for nursing staff, nursing staff comments | 1. Significant improvement in POMS scores (P<0.05). 2. Positive social and psychological effects. | |
| Wada et al 8 50 51 52 53 54 | 23 subjects (six men) mean age 85 | Health service facility, Japan | Free group interaction with Paro or placebo Paro. Randomised controlled trial. | Four sessions (1 hour)/week for 4 weeks | POMS, face scale, urinary tests and nursing comments | 1. Improvement in mood and reduction in depression and dejection levels in both groups. 2. Urinary results suggest Paro interaction reduces stress. | |
| Valentí Soleret al 25 | Phase 1: 20 subjects (10 men), mean age 77.9 years Phase 2: 17 subjects (eight men), mean age 79 years All subjects were diagnosed with dementia | Day care centre, Spain | Phase 1: Supervised group therapy (cognitive and physical) with NAO. Phase 2: Supervised group therapy (cognitive and physical) with Paro. Crossover study. | Two sessions (30–40 min)/week for 3 months | GLDS, sMMSE, MMSE, NPI and AI |
Phase 1: 1. Increase in deterioration scores. 2. Significant decrease was seen in irritability scores and total NPI scores. Phase 2: 1. Increase in deterioration scores. | |
| Lane et al 55 | 23 subjects (all men) aged 58–97 years, 19 had been diagnosed with dementia | Veteran residential care facility, USA | Supervised one-on-one interaction with Paro. Pilot study. | Three sessions (>5 min) across 1 year | Behaviour (assessment form designed by authors of study—no formal name) Assessments made before, during and after interaction. | 1. Increase in observed positive affective and behavioural indicators (eg, bright affect, interacting with others, calm). 2. Decrease in observed negative affective and behavioural indicators (eg, anxious, sad and yelling). 3. Those who best responded to Paro were calm and approachable at the before interaction. | |
| Moyle et al 21 | 415 subjects (101 men) mean age 85 years. All subjects were diagnosed with dementia | Long-term care facilities, Australia | Free one-on-one interaction with Paro switched on, Paro switched off or TAU. Cluster-randomised controlled trial. | Three sessions (15 min)/week for 10 weeks | Video observations (at baseline and weeks 1, 5 10 and 15) and CMAI (at baseline and weeks 10 and 15) | 1. Subjects in Paro switched on group were more verbally and visually engaged compared with Paro switched off group. 2. Both Paro switched on and switched off groups had reduced neutral affect compared with TAU group. 3. Paro switched on was more effective than TAU at improving pleasure and agitation. | |
| Petersen et al 56 | 61 subjects (14 men) mean age 84.3 years. All subjects were diagnosed with dementia | Dementia units, USA | Supervised group interaction with Paro or other activity (music, physical activity and mental stimulation). Randomised controlled trial. | Three sessions (20 min)/week for 20 weeks | RAID, CSDD, GLDS, pulse rate, pulse oximetry, GSR and medication | 1. Anxiety scores, depression scores and pulse rate in Paro group all significantly decreased over the study period compared with control group. | |
| Moyle et al 12 | Five subjects (all female) mean age 84 years. All subjects were diagnosed with dementia | Nursing home, Australia | Supervised one-on-one interaction with CuDDler. Pilot study. | Three sessions (30 min)/week for 5 weeks | CMAI (before and after each session) | 1. Agitation scores increased in four of the five patients across the 5-week study period. | |
| Cognitive training | Tanaka et al 24 | 34 subjects (all female), aged >65 years, living alone | Participant’s home, Japan | Living with Nodding Kabochan or control robot (same design as Nodding Kabochan, but cannot talk or nod). Randomised controlled trial. | 8 weeks | Questionnaires, BMI, cognitive tests, APG and blood and saliva samples | 1. Cognitive scores (MMSE+components of Cognistat) were improved in Nodding Kabochan group. 2. Saliva cortisol level was decreased in Nodding Kabochan group. 3. Higher reports of loss of fatigue, enhancement of motivation and healing in Nodding Kabochan group. |
| Valentí Soler et al 25 | Phase 1: 101 subjects (13 men), mean age 84.7 years Phase 2: 110 subjects (11 men), mean age 84.7. All subjects were diagnosed with dementia. | Nursing home, Spain | Phase 1: Supervised group therapy (cognitive, musical and physical) with Paro or NAO or TAU. Randomised controlled trial. Phase 2: Supervised group therapy (cognitive, musical and physical) with Paro or Dog or TAU. Randomised controlled trial. | Two sessions (30–40 min)/week for 3 months | GLDS, sMMSE, MMSE, NPI, APADEM-NH and the QUALID |
Phase 1: 1. Decreased apathy in NAO and Paro groups. 2. Increased delusions in the NAO group. 3. Increased irritability in both robot groups. 4. Decrease in scores on the MMSE, but not the sMMSE, in the NAO group. 5. There were no significant differences between NAO and Paro groups. Phase 2: 1. Increase QUALID scores in the Paro group compared with the TAU group 2. Increased hallucinations and irritability in both the Paro and dog groups compared with the TAU group. 3. Increased disinhibition in Paro group compared with dog group. 4. Decreased night-time behaviour disturbances in the Paro group compared with dog group 1. | |
| Kim et al 26 | 71 healthy subjects, aged >60 years, based in community | Assessment centre, South Korea | Supervised group interaction with either Silbot and Mero robots (robot cognitive training) or onscreen quiz (traditional cognitive training) or received no cognitive training (control). Randomised controlled trial. | Five sessions (90 min)/week for 12 weeks | MRI, neuropsychometric tests and Alzheimer’s Disease Assessment Scale | 1. An attenuation of cortical thinning in both intervention groups. 2. Robot therapy showed significantly reduced cortical thinning in the right and left anterior cingulate cortices and small areas of right inferior temporal cortex compared with traditional intervention. 3. Global topological organisation of white matter corticocortical networks was decreased in the control group and the rate of decrease was significantly less in both the intervention groups. 4. Robot therapy had greater nodal strength in the left rectus gyrus. 5. The intervention groups showed greater improvement in the executive function. 6. In the general cognitive and visual memory tasks, the traditional intervention group had greater improvement than in the robot group. 7. The robot group did not outperform the traditional group on any neuropsychological test. | |
| Tapus et al 28 57 58 59 | Three subjects (all female) aged >70 years with dementia (some reports say four subjects, with one male) | Care facility, USA | Individual interaction (musical, cognitive game) with Bandit (compared with an onscreen simulation of Bandit in some reports). Pilot study. | Session (20 min)/week for 12 months | sMMSE, response time, correctness evaluation and questionnaire | 1. Robot encouragement improved response time. | |
| Hamada et al 60 | 11 subjects with dementia | Nursing home, Japan | Interaction with AIBO, either individually playing a card game or in a group playing a ball game. Pilot study. | Session/day for 5 days | Frequency of activity in video observation | 1. Improvement in game performance. | |
| Wada et al 27 61 | 14 subjects (four men) mean age 79.2, with dementia | Clinic, Japan | Free group interaction with Paro. Pilot study. | One session (20 min) | EEG recording, questionnaire | 1. Improvement in cortical neurons activity of sevens patients, especially in patients who liked the robot. | |
| Social facilitator | Kramer et al 29 | 18 subjects (all female) with dementia | Nursing home, participants room, USA | Supervised one-on-one interaction with AIBO, dog or no object. Crossover study. | One visit (~3 min)/week for 3 weeks (each week is a different interaction) | Observed behaviour seen in video-recording | 1. All visits generate interactive behaviour with visitor. |
| Šabanović et al 15 | Seven subjects with dementia | Dementia rehabilitation wing, USA | Supervised group interaction with Paro. Pilot study. | One session (30–45 min)/week for 7 weeks | Observed behaviour of primary and non-primary interactor seen in video-recording | 1. PARO increases activity in particular modalities of social interaction, which vary between primary and non-primary interactors. 2. PARO improved activity levels. | |
| Sung et al 16 | 12 subjects (nine men), mean age 77.25 | Residential care facility, Taiwan | Supervised group interaction with Paro. Pilot study. | Two sessions (30 min)/week for 4 weeks | ACIS, Activity Participation Scale | 1. Significant improvement in communication and interaction skills. 2. Significant improvement in activity participation. | |
| Kidd et al 17 62 | 23 subjects, aged 60–104 years, with high functioning in one nursing home and schizophrenia and/or dementia in the other | Nursing homes, US | Supervised group interaction with Paro switched on, Paro switched off or no object. Crossover study. | One session (20 min)/2 weeks (in site A) or per month (in site B) for 4 months (five sessions vs four sessions) | Questionnaire and observation | 1. In switched on Paro group, there was an increase in social interactions, even more in the presence of caregivers or experimenters. 2. Switched on Paro also generated feel-good experiences. | |
| Sakairi63 | Eight subjects (two men) aged 68–89 years, with dementia | Group home, Japan | One-on-one interaction with AIBO. Pilot study. | One session (30 min) | N-dementia scale, MMSE, behaviour scale and video observation | 1. Improving communication with staff in a group home and establishment of friendly relations with occupants. | |
| Chu et al 18 | 139 subjects (95 men) aged from 65 to 90 years, with dementia | Residential care facilities, Australia | Supervised group interaction with Sophie and Jack. Observational study. | Two sessions (4–6 hours) across 5 years | Behaviour (assessment form developed by authors—no formal name). Assessments made every 5 min during session. | 1. Increase in social engagement of subjects across the 5-year study period. | |
| Jøranson et al 19 | 23 subjects (seven men) aged from 62 to 92 years. All subjects had a dementia diagnosis | Nursing homes, Norway | Supervised group interaction with Paro. Observational study. | Two sessions (30 min)/week for 12 weeks | Observed behaviour as seen in video recording | 1. Subjects with mild to moderate dementia paid more attention to Paro than those with severe dementia. 2. Over the study period, there was an increase in interactions with other subjects and a decrease in interactions with Paro. | |
| Companionship | Banks et al 30 | 38 subjects | Nursing home, USA | Free one-on-one interaction with AIBO/dog or no object. Randomised controlled trial. | One session (30 min)/week for 8 weeks | Modified LAPS, UCLA LS | 1. Dog and AIBO therapy equally reduced loneliness compared with control (more improvement in most lonely participants; in the control group, the most lonely became more lonely). 2. Residents became significantly and equally attached to AIBO and dog. 3. Attachment was not the mechanism for reduced loneliness in dog or AIBO therapy. |
| Robinson et al 31 64 | 34 subjects, aged >55 years | Retirement home, New Zealand | Group or individual interaction with Paro or alternative activity. Randomised controlled trial. | Two sessions (1 hour)/week for 12 weeks | UCLA LS, GDS, QoLAD, interview questionnaire and observations | 1. Loneliness scores significantly decrease in the Paro group compared with control. 2. Residents enjoyed sharing, interacting and talking about Paro. | |
| Kanamori et al 7 | Six subjects (one man) aged >64 years. Five separate control subjects used for CgA measurement. | Nursing home/participant’s home, Japan | Free interaction with AIBO. Control group for CgA measurements had no intervention. Pilot study. | Four sessions (1 hour)/week for 7 weeks | Scores of emotional words, amount of speech and satisfaction, AOKLS, SF-36 and salivary CgA | 1. Significant reduction of loneliness. 2. Improvement in health-related quality of life. 3. Decrease in salivary CgA, an indicator of sympathetic adrenal system activity. 4. Increase in emotional words, amount of speech and satisfaction exhibited. | |
| Physiological therapy | Robinson et al 32 | 21 subjects (seven men) mean age 84.9 years | Residential care facility, New Zealand | Supervised one-on-one interaction with Paro. Pilot study. | One session (10 min) | Blood pressure reading: before during and after interaction | 1. Significant reductions in systolic and diastolic blood pressure. 2. Reduced systolic blood pressure was sustained after Paro was taken away. 3. Reduced diastolic blood pressure was not sustained after Paro was taken away. 4. Data suggest average heart rate decreased. |
| Wada et al 33 65 66 67 68 69 | 12 subjects, aged 67–89 years, with mixed cognitive function | Residential care facility, Japan | Free individual/group interaction with Paro. Pilot study. | One session (9.5 hours)/day for 4 weeks | Urinary tests, interviews and video recording observation | 1. Increase in social interaction and density of social networks. 2. Improvement of subjects’ vital organs reaction to stress. |
ABMI, Agitated Behaviours Mapping Instrument; ACIS, Assessment of Communication and Interaction Skills; AES, Apathy Evaluation Scale; AI, Apathy Inventory; AIBO, Artificial Intelligence Robot; AOKLS, Ando Osada and Kodama Loneliness Scale; APADEM-NH, Apathy Scale for Institutionalized Patients with Dementia Nursing Home version; APG, Accelerated Plethysmography; BARS, Brief Agitation Rating Scale; BMI, body mass index; CAM, Confusion Assessment Method; CDR, Clinical Dementia Rating Scale; CgA, Chromogranin A; CMAI, Cohen Mansfield Agitation Inventory; Coop/Wonca, Mood scale; CSDD, Cornell Scale for Symptoms of Depression in Dementia; GBS, Gottfries-Bråne-Steen Scale; GDS, Geriatric Depression Scale; GLDS, Global Deterioration Scale; GSR, Galvanic Skin Response; IPPA, Goal attainment scale; LAPS, Lexington Attachment to Pets Scale; LMBS, Lawton’s Modified Behaviour Stream; MMSE, Mini Mental State Examination; NPI, Neuropsychiatric Inventory; OERS, Observed Emotion Rating Scale; POMS, Profile of Mood States; QoLAD, Quality of Life in Alzheimer’s Disease Scale; QUALID, Quality of Life Scale; RAID, Rating Anxiety in Dementia Scale; SF-36, Short Form Health Survey; sMMSE, Severe Mini Mental State Examination; TAU, treatment as usual; UCLA LS, University of California Los Angeles Loneliness Scale.