Opinion piece written by Assoc Prof Ng Kok Pin and Assoc Prof Philip Yap

Rose, who shares a close relationship with her daughter Mary, has been living with dementia for eight years. At a clinic visit, Mary breaks down in tears while talking about her mum’s progressive deterioration in recent months. Rose fails to recognise her on occasions, and can barely string together words to form coherent responses. 

“She is my best friend and agony aunt, I wish I could have her back”, Mary struggles to hold back her tears as she speaks. She regains her composure, whips out her phone and exclaims, “ChatGPT is my agony aunt now!” 

Dementia has been described as a disease that takes the person away and leaves the body behind. 

On the other hand, the congenial and obliging responses of artificial intelligence (AI) chatbots have led to people becoming so captivated that they risk becoming disengaged from reality. Indeed, the human-like intelligence of AI can blur the line between what is authentically human and what is artificial. When the phenomenal and growing ability of AI is juxtaposed with the relentless decline of a person with dementia, AI may appear more human. 

And this is where we can get it wrong. A human is so much more than their intelligence and communication skills. AI’s glib words will never be enough to make it human. What it can do, however, is be the tool that enables better care for those living with dementia. 

What it means to be human 

AI mimics the human intellect, and the rise of intellectualism has played a part in making us confuse even AI for humanness. 

The importance given to intellect, individuality and self-actualisation in today’s society has seen them being regarded as markers of our identity and dignity, at the expense of traditional sources of meaning and value that had their roots in culture, religion and the community. 

The present-day culture valorises intellectualism and productivity, which philosopher Michael Sandel calls a “tyranny of merit” with its emphasis on talent and output. Seen through this lens, dementia connotes failure while AI shines brilliantly. However, we believe that asking questions about dementia can help us rediscover the dimensions that truly make us human. 

The late Professor Tom Kitwood, widely recognised as the father of person-centred dementia care, posited that personhood transcends personal abilities and attributes. A human possesses a unique identity that is shaped by his interaction with others as well as his lived experiences. He has a capacity for relationships, personal values and preferences, and a legacy that endures in those who love and cherish him. 

In the advanced stages of dementia, Rose may seem so different from the mum Mary once knew, but her personhood remains and is upheld through the relationship she shares with Mary. She cannot be replaced, and even with advanced dementia her emotions remain intact – of joy, pleasure and peace, and also fear and anxiety. 

Her value to Mary does not depend on her instrumental worth or her ability to reason and recall. Mary draws lessons in compassion and unconditional love by spending time with her mother. (Disclaimer: Rose and Mary are composite characters we have created, based on our interactions with patients and their families over the years.) 

In contrast, despite its mimicry of linguistic abilities, AI has no inner world of thoughts, feelings or awareness. With no lived experience, it cannot speak of a past, a future or a mindful moment in the present. Devoid of a physical body, it has no visceral understanding of pain, pleasure or desire, which are the essence of the human experience. AI can render a most empathetic response with no feelings, and generate a bittersweet poem about love and loss without having loved or understood loss. 

The conversational capability of AI is the result of drilling and fine-tuning on massive amounts of linguistic data to optimise the task of predicting the continuation of a sentence. Although we can have a relational experience when using AI, it is merely a reflection of its iterative algorithmic training and not a genuine interpersonal connection. 

AI can play its part 

While AI can never replace Rose, it can enhance the treatment and care of people with dementia by enabling early diagnosis, continuous monitoring and personalised support. Through various modes of sensors, AI can provide real-time remote monitoring of someone with dementia, and AI digital assistants can help them remain relatively independent through reminders to take their medication, for example. 

Social robots or virtual avatars can provide companionship for people with dementia. Some can even chat with them in multiple languages and dialects, alleviating their social isolation and loneliness. AI-driven technologies even hold the potential to facilitate care planning and surrogate decision-making for people with dementia who have lost mental capacity. By combing through relevant personal data, e-mails and social media posts, AI can predict their preferences in particular situations which family members and care professionals can take into account, when decisions need to be made. 

AI can even conjure up digital versions of people and places that mattered to someone living with dementia to bring them some joy and comfort. This tool should be used only like an old photograph to enable the patient to revisit old memories, and the likenesses must never be used to deceive them. That would be an affront to their dignity as human beings. 

The issues surrounding AI and dementia oblige us to confront and reaffirm what makes us truly human. People with dementia, in their vulnerability, are not less human but a testament to the essence of humanity. They call upon our human virtues of benevolence, faithfulness and capacity to love people simply for who they are, not for what they can do. More on this topicThe one role AI shouldn’t replace – caring for othersCould dementia patients benefit from an AI companion?

AI, on the other hand, simulates what we do but not who we are. The test of our humanity is whether we can cherish and protect the unconditional value of every person, even when some of their attributes are diminished by dementia. 

At the end of the clinic visit, Mary bends over to hug her mum and gives her a kiss on the cheek. She says: “But she is still my bona fide best friend and forever mum. We have been through the vagaries of life together; I know she always understands.” 

As we commemorate World Alzheimer’s Month this September, let us reaffirm that the rise of AI must be accompanied by a greater recognition of the dignity of every person, dementia notwithstanding. 

Associate Professor Ng Kok Pin is senior consultant at the National Neuroscience Institute’s department of neurology. Associate Professor Philip Yap is senior consultant at Khoo Teck Puat Hospital’s department of geriatric medicine and chairman of Dementia Singapore.