Think Before You Comfort: Reflective Cognitive Alignment for Protocol-Grounded Elderly Stimulation Agents

Cognitive Stimulation Therapy (CST) offers non-pharmacological support for elders with cognitive impairment, yet scalability remains constrained by reliance on trained facilitators and severe data scarcity, particularly for privacy-sensitive, low-resource languages such as Cantonese. While Large Language Models (LLMs) show promise for automated companionship, they often struggle to balance empathetic engagement with adherence to cognitive stimulation guidelines. We propose a framework addressing these challenges along two complementary axes. First, STaR-CS (Style-Transfer and Role-Conditioned Cognitive Stimulation) synthesizes multi-party dialogues through facilitator style modeling and structured skeleton extraction, mitigating data barriers. Building upon this corpus, the Reflective Cognitive Alignment (RCA) framework models stimulation interactions as a sequential decision process, integrating Protocol-Constrained Chain-of-Cognition (PC-CoC) for structured reasoning and Inference-Time Value Alignment (IVA) for principled response selection based on safety and engagement goals. Evaluations across six backbone LLMs and two independent judges show that RCA consistently improves protocol adherence, safety, and group facilitation over standard prompting baselines. Our code is available at https://github.com/jiangjyjy/RCA_Agent.