Digital Reminiscence for Predeath Grief Among Family Caregivers of Patients With Dementia: A Pilot Randomized Clinical Trial.

Importance: Family caregiving for individuals with Alzheimer disease and related dementias (ADRD) is associated with significant distress related to physical, emotional, and interpersonal losses. Reminiscence therapy may help family caregivers preserve connection, reframe loss, and reduce predeath grief, although its evaluation among caregivers remains underexplored. Objective: To assess the feasibility, acceptability, and preliminary efficacy of a digital reminiscence platform (Living Memory Home for Dementia Care Pairs [LMH-4-DCP]) for ADRD caregiver-care recipient dyads. Design, Setting, and Participants: This multisite, participant-blinded pilot randomized clinical trial was conducted virtually at Weill Cornell Medicine, New York, New York, and the University of Southern California, Los Angeles. Eligibility included being a primary caregiver for a family member with ADRD, age 18 years or older, and fluency in English. Participants were randomized in a 1:1 ratio and completed baseline and 2-week postintervention assessments. Enrollment occurred between November 6, 2024, and April 15, 2025. Data analyses were conducted from August 1 to 31, 2025. Intervention: LMH-4-DCP is a digital intervention for ADRD caregiver-care recipient dyads to engage in reminiscence activities. Participants were randomized to the LMH-4-DCP or an attention control condition, which included a restricted version of the platform without reminiscence features. Main Outcomes and Measures: Outcomes, including feasibility, acceptability, predeath grief, and relationship quality were assessed at baseline and 2-week follow-up. Results: Of 174 screened caregivers, 106 were eligible, and 68 enrolled. Among the enrolled participants, the mean (SD) age was 49.4 (13.7) years (range, 23-90 years). Fifty-four participants (79.4%) were female, and 39 (57.4%) were caring for a parent. Fifty-four randomized participants completed follow-up assessments (27 per group). Feasibility and acceptability of LMH-4-DCP was demonstrated by a study completion rate of 120 of 136 assigned assessments (88.2%). Most participants in the intervention group reported that LMH-4-DCP was easy to use (20 of 27 [74.1%]) and had well-integrated features (21 of 27 [77.8%]). Intervention participants showed reduced predeath grief (Cohen d = -0.38; mean [SD] reduction, -3.29 [8.64]; P = .03) after 2 weeks of using LMH-4-DCP. Compared with controls, intervention participants demonstrated greater reductions in predeath grief. Improvements in relationship quality were observed for intervention participants, but the difference was not significant. Conclusions and Relevance: This pilot randomized clinical trial demonstrated the feasibility, acceptability, and preliminary efficacy of LMH-4-DCP in reducing caregiver grief, with improvements in caregiver-care recipient relationship quality. These findings should inform platform refinements and a future, definitive efficacy trial. Trial Registration: ClinicalTrials.gov Identifier: NCT06225986.