DementiaCare-Bench: A Modality-Validated Video Benchmark

Dementia affects an estimated 57 million people worldwide, and for most families the hardest part of care is not memory loss but the behavioral and psychological symptoms of dementia (BPSD): agitation, wandering, resistance to care, sundowning. Understanding these symptoms requires more than recognizing the behavior itself; it also requires knowing what happened beforehand. The same behavior may call for a different response depending on its trigger. Video-language models (VLMs) could potentially support caregivers, yet no existing benchmark evaluates this capability. To fill this gap, we present DementiaCare-Bench: 56 professionally produced caregiver training videos segmented into 94 clips across nine BPSD categories, with 2023 questions generated by a multi-agent pipeline that grounds every clinical claim in a verbatim transcript span. Each question is then probed under four visual conditions and labelled by the least it requires, so its visual demand is measured rather than assumed. Measurement contradicts intent: we wrote 77.7% of the questions to require ordered frames, and 34.8% do. Across 12 current VLMs the pattern is uniform. The best reach 85% overall, but that average is carried by questions a language model can answer from clinical knowledge alone; accuracy falls by 17 points on average on questions that require the ordered clip, and a leading open model scores at chance on judging whether a caregiver's response was appropriate. A lightweight LoRA fine-tune, DemCare-VLM, moves video dependence from -3.3 to +4.5 points, so what the benchmark exposes can be repaired and not only measured.