A web tool designed to spark reminiscence could help people with dementia and their caregivers feel more connected to each other and less impacted by feelings of pre-death grief, according to a clinical trial co-led by USC and Weill Cornell Medicine published in JAMA Network Open.
With features such as photo albums, autobiographical questions, and journaling prompts, the Living Memory Home for Dementia Care Pairs (LMH-4-DCP) website is a customizable virtual space that facilitates collaborative and interactive reminiscence therapy for both dementia patients and caregivers, said lead author Francesca Falzarano , assistant professor at the USC Leonard Davis School of Gerontology.
Reminiscence therapy for dementia includes guided conversations about past experiences and can involve music, art, familiar objects, or other sensory items. The goal is to lessen anxiety and promote well-being and connection, Falzarano explained.
“The idea is that getting them talking about those memories will promote the relationship between the person with dementia and the caregiver, which can improve numerous outcomes. If the caregiver has a better relationship with the person with dementia, they are more likely to keep them at home, and they're less likely to transition into long-term care,” she said. “We also want to nurture the personhood and dignity of the person with dementia, document their memories while we still can, and alleviate pre-death grief.”
Pre-death grief, which includes both current and anticipated losses prior to a loved one’s death, is a common phenomenon for patients and families affected by dementia, Falzarano said.
“Even while the person with dementia is still alive, that relationship that once existed – whether it was a husband and wife, or mother and daughter – it can be transformed overnight,” she said. “For caregivers, everything that you knew about the person could be gone; you lose that existing relationship and support. Patients who are aware of their diagnosis can be grieving the loss of independence, skills, and memories. You lose a future you might have planned, and then you also are anticipating all of the losses that are going to unfold because of the disease.”
Promising early results
Trial participants included 34 pairs consisting of people with mild to moderate dementia and their caregivers, or caregiving dyads. Dyads were randomly assigned to either the full LMH-4-DCP app, complete with reminiscence therapy activities, or to a limited version of the app without access to reminiscence features. Each dyad used their assigned version of the app at least two times per week for two weeks and completed baseline and post-intervention surveys regarding usability of the app as well as on feelings of grief and relationship quality.
Study results not only indicated that the LMH-4-DCP app was feasible and acceptable for caregiving dyads to use; it also showed that using the full version of the app was associated with significant reductions in feelings of pre-death grief. In addition, there were minor increases in relationship quality after the two-week period for the users with access to reminiscence features versus those without access. While not quite reaching statistical significance in this small trial, the trend toward significance may indicate that a larger study sample or a longer period of usage may provide more improvement and shows the need for further study, Falzarano said.
“I feel like we got a lot closer”
Beyond the encouraging survey scores, caregivers shared their positive experiences with LMH-4-DCP in feedback to investigators. An open-ended question asked respondents about what they noticed regarding memory recall, interpersonal engagement, and relational closeness while using the app with their loved one.
When participants were asked whether they would continue to use the app after the study:
The power of sharing memories
LMH-4-DCP is modeled after the original Living Memory Home (LMH) web app, a digital bereavement platform for individuals grieving the death of a loved one developed by collaborators at Weill Cornell, including Holly Prigerson, co-director of the Center for Research on End-of-Life Care and senior author of the current study. Previously, LMH showed that its reflective journaling prompts and other bereavement activities reduced prolonged feelings of grief.
“People may not be aware of how severely distressing and disabling grief is,” Prigerson said. Pre-death grief is remarkably similar to post-death grief, which has been more extensively studied for its role in Prolonged Grief Disorder. Unlike natural grief that diminishes over time, Prolonged Grief Disorder involves pervasive and profound distress, hopelessness and impaired daily functioning, she explained.
“We have found grief to be the strongest predictor of suicidal thoughts and behaviors; it is also linked to serious medical outcomes such as heart attacks and cancer,” Prigerson said. “Detecting and addressing grief will help reduce these related risks.”
The similarities between bereavement and reminiscence therapy activities inspired the researchers to adapt the web tool for use with caregiver dyads, Falzarano explained.
“In the original Living Memory Home website, recently bereaved individuals would journal and do different activities to honor, reflect and reminisce on the deceased. This had really positive effects on bereavement adjustment; the severity of their post-death grief was significantly reduced,” Falzarano said. “A lot of the terms they were using were very bereavement-focused, but the concepts were exactly the same as in reminiscence therapy. Reminiscence therapy is widely used for people with dementia in general and can trigger memory recall, but there hasn’t been a ton of rigorous research into the effectiveness of it.”
Looking to the future, Falzarano aims to take advantage of the LMH-4-DCP’s scalability and conduct larger and more in-depth clinical trials. She also wants to develop new tools that can provide a more comprehensive and inclusive picture of how the app can help everyone involved.
“The next step is not only testing the efficacy of this reminiscence therapy tool with a very large, nationally representative sample, but also the inclusion of the person with dementia. I hope this establishes a line of research that we should be targeting both the caregiver and the care recipient, and that includes measurement,” she said. “We can't just give the same questionnaire that we give to a caregiver to a person with dementia. What are the best ways to develop effective measures for people with dementia so we can know whether this is something that can help alleviate some of the stress or grief that they're experiencing? To have a tool to assess that – and then an intervention to address that – could be really powerful.”
About the study
The study, “ Digital Reminiscence for Pre-Death Grief in Dementia Family Caregivers: A Pilot Randomized Trial ,” appears April 22, 2026 in JAMA Network Open . Falzarano and Prigerson’s coauthors include Annabelle Greenfield of the USC Leonard Davis School; Sydney Saviano, Sindhu Kolla, Sosi Korian, Francesco Osso, Joseph Miller, and Paul Maciejewski of Weill Cornell Medicine; and Heather Whitson of Duke University.
This research is supported by National Institute on Aging (NIA) grants R21AG077144 (Falzarano/Prigerson), P30AG072958 (Whitson), and R00AG073509 (Falzarano); National Cancer Institute grant R35 CA197730 (Prigerson); and National Center for Advancing Translational Sciences award UL1TR002384 supporting the Weill Cornell Medicine Clinical and Translational Science Center.
JAMA Network Open
10.1001/jamanetworkopen.2026.8278
Randomized controlled/clinical trial
People
Digital Reminiscence for Predeath Grief Among Family Caregivers of Patients With Dementia
22-Apr-2026
The authors declare that they have no conflicts of interest.