# DemMA: Dementia Multi-Turn Dialogue Agent with Expert-Guided Reasoning and Action Simulation

arXiv: https://arxiv.org/abs/2601.06373 · HTML: https://mlsanity.com/paper/2601.06373/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 3 of its 3 references that are in the map.
- First posted on arXiv 10 Jan 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 3 of 3)

- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [The Curse of Recursion: Training on Generated Data Makes Models Forget](https://mlsanity.com/paper/2305.17493/) (2023)
- [Rethinking Chain-of-Thought from the Perspective of Self-Training](https://mlsanity.com/paper/2412.10827/) (2024)

## Built on by (most cited first, 2 of 2)

- [Can the Environment Speak for Itself? T2-GRPO: A Turn-Trajectory Group Relative Policy Optimization for Caregiver Agents](https://mlsanity.com/paper/2606.08875/) (2026)
- [AP-GRPO: Anchor-Gated Phonetic Alignment with Policy Optimization for Pathological Speech Reconstruction](https://mlsanity.com/paper/2606.15540/) (2026)

## Abstract (arXiv)

Simulating dementia patients with large language models (LLMs) is challenging due to the need to jointly model cognitive impairment, emotional dynamics, and nonverbal behaviors over long conversations. We present DemMA, an expert-guided dementia dialogue agent for high-fidelity multi-turn patient simulation. DemMA constructs clinically grounded dementia personas by integrating pathology information, personality traits, and subtype-specific memory-status personas informed by clinical experts. To move beyond text-only simulation, DemMA explicitly models nonverbal behaviors, including motion, facial expressions, and vocal cues. We further introduce a Chain-of-Thought distillation framework that trains a single LLM to jointly generate reasoning traces, patient utterances, and aligned behavioral actions within one forward pass, enabling efficient deployment without multi-agent inference. Extensive evaluations with experts, medical students, and LLM judges demonstrate that DemMA significantly outperforms strong baselines across multiple metrics.