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

Abstract: Simulating dementia patients with 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.