Utilization of Heritage Manifestations in a Reminiscence Programme (App) Directed at Older Adults with and Without Neurocognitive Disorder, Employing AI: A Pilot Study in Portugal and Spain.

Cultural and intangible heritage has been part of human daily life since time immemorial, fulfils a function within the community and acts as an element of identity. Its potential as a stimulus in Reminiscence Therapy (RT), however, has been scarcely explored, despite well-documented evidence on the role of music, crafts or sports as facilitators of autobiographical recall. This pilot study had three operational objectives: (i) to design a reproducible protocol for selecting elements of intangible cultural heritage (traditional oral literature and traditional dances) suitable for personalised RT; (ii) to develop and field-test the first prototype of the LONG-REMI App, an AI-supported tablet application that delivers these stimuli in an individualised manner; and (iii) to examine the impact of those stimuli on memory recall, communication and interaction in older adults with and without neurocognitive disorder. Pilot, prospective, multicentre, mixed-methods study with a participatory observational component, conducted in six institutions (three Day Care Centres in Catalonia (Spain) and three centres in Portugal) between February 2021 and April 2022. Fifty-six participants aged ≥ 65 years were enrolled (n = 21 without cognitive decline, recruited from two centres; n = 35 with mild or moderate cognitive decline, recruited from four day-care centres). Mean age was 80.71 ± 6.82 years (range 66-94); 41 (73.21%) were women and 43 (76.78%) had a low educational level (including two illiterate participants). Cognitive status was classified using Reisberg's Global Deterioration Scale (GDS 3 and 4) and the Mini-Mental State Examination (MMSE; group with cognitive decline: 22.26 ± 5.90, range 7-30). Each participant attended four weekly individual 45-minute sessions on Android tablets. The App database contained more than 500 multisensory stimuli organised in two difficulty modalities (low / high). Data were collected through the Visual Analogue Scale (VAS, 1-10) for usability and satisfaction; the Spanish-adapted Computer System Usability Questionnaire (CSUQ, 7-point Likert); and the Spanish-validated PANAS, administered before and at the end of the intervention. In addition, a structured observation grid (memory recall, verbal and non-verbal interaction), audio-video recording and facilitators' field notes supported the qualitative arm. Content validation of the App database was carried out by the multidisciplinary research team itself, through consensus during project meetings; a formal Delphi with an external panel is foreseen for the planned randomised trial. Stimuli combining rhyme and music (songbook items and ballads) and stimuli supported by video produced the highest frequency of recall episodes and of communication / interaction events. Brief audio-only stimuli (proverbs and nursery songs without video) elicited fewer recall events and were associated with observed disengagement. Usability and satisfaction were highly perceived in both groups: VAS usability 7.75 ± 1.88 and VAS satisfaction 8.38 ± 1.57 on a 1-10 scale; the CSUQ overall score was 6.95 ± 0.22 in the group without cognitive decline and 5.44 ± 1.09 in the group with cognitive decline (1-7 Likert). PANAS scores showed a statistically significant shift in positive affect from pre- to post-intervention (28.86 ± 8.88 vs. 36.70 ± 9.43; Z = - 4.18; p < 0.001), while no significant change was observed in negative affect (12.09 ± 3.19 vs. 11.89 ± 3.00; p = 0.688). Participants completed on average 3.59 ± 0.40 of the four planned sessions. Traditional oral literature and traditional dance, when delivered through an AI-supported App, can act as effective triggers for reminiscence in older adults with and without cognitive decline. The study contributes (a) a replicable protocol for cross-cultural selection of intangible heritage stimuli, (b) preliminary evidence on which formats (audio + video, rhyme + music) are most effective, and (c) an open methodological framework for future randomised, longitudinal trials.