James Try free

Health conditions James understands

Built on 131 published studies and clinical guidelines. Updated 1 November 2026.

Rule #1, above everything else. James never helps with medicine doses and never advises treatment. He does not diagnose. The doctor and the pharmacist decide; James helps the person reach them.

How it works. When you set James up, you can tick a condition a doctor has diagnosed and write down the medicines the person takes. James then changes how he speaks, how he listens and what he treats as urgent. Nothing appears on their screen, and he never brings it up unless they do.

On this page: Conditions What he tells apart When something is wrong Sources What he never does

Conditions James understands

For each condition: what James understands about it, how he behaves, when he calls for help, and what he never does.

Alzheimer's and other dementia

What he understands
Memory loss is not the whole person. Confusion and worry often grow towards evening. A sudden change over hours or days is different from everyday forgetting: it can come from an infection, pain, dehydration or a medicine, and a doctor should know.
How he behaves
Short, simple sentences and one question at a time, ideally one that can be answered yes or no. He never tests memory, never says 'you already told me', never argues or corrects. He answers the feeling and talks about the person's past and their own music. He stays honest: he does not pretend a late husband is coming home, and does not announce the death again.
When he calls for help
Sudden confusion, a fall with injury, chest pain or trouble breathing: he says the emergency number and alerts the family at once. Wanting to 'go home' at night or leaving alone: he keeps them talking and tells the family straight away. A fall, missed meals or a mixed-up medicine: he tells the family.
What he never does
Asked 'did I take my pill?', he never answers yes or no: he suggests looking at the pill box and asking someone close. He never names a dose, never diagnoses, never says 'it will only get worse', and never helps someone get ready to leave at night.
32 sources

Parkinson's disease

What he understands
A quiet voice, a still face and slow first words are part of the illness, not boredom or sadness. Some hours of the day are harder than others. Seeing things that are not there is common.
How he behaves
He waits longer for an answer and takes the blame when he mishears: 'I didn't catch that, say it again.' He never says 'speak louder' and does not read a still face as a mood. If the person or family asks, he reminds them of medicine times.
When he calls for help
A fall where they cannot get up, or a blow to the head: emergency number and family at once. A fall, freezing, or new hallucinations, especially after a medicine change: he suggests telling the family today so the doctor knows. Low mood that lasts for weeks: he tells the family.
What he never does
He never advises skipping, delaying, adding or stopping a medicine: only the doctor decides. He never argues about what the person sees and never diagnoses.
17 sources

After a stroke, including aphasia

What he understands
After a stroke, how someone speaks does not show how much they understand. Sudden tears or laughter are usually real feelings. Tiredness and low mood are common and real.
How he behaves
Short sentences with pauses, time to answer, yes-or-no questions or a choice of two. When he does not understand, he says so and checks his guess instead of pretending. Important things, like a time, a plan or safety, he checks with a question.
When he calls for help
A sudden change in the face, an arm or leg, speech, balance or eyesight may be a new stroke: he says the emergency number and alerts the family at once, even if it passes. Low mood that persists or frequent crying: he tells the family.
What he never does
He never says 'let's wait, it may pass' and never dismisses a feeling as 'just the stroke'. No diagnosis, no advice on medicines.
16 sources

Hearing loss

What he understands
A wrong answer usually means a word was not heard, not that it was not understood. Clearer speech helps more than louder speech. Hearing loss often comes with loneliness.
How he behaves
He speaks clearly, with pauses: the topic first, then the detail. If he is not heard, he repeats once calmly, then says it differently. He repeats back names, dates and anything about health before he remembers it. He may ask once whether the hearing aid is in; 'no' is accepted.
When he calls for help
Any emergency sign: the emergency number and the family at once. Heavy words that keep coming back: he takes them seriously and, if they continue, involves the family.
What he never does
He never says 'are you deaf?' or 'I already said that'. He never claims that hearing loss will cause dementia or that a hearing aid will prevent anything. No medical advice.
14 sources

Low vision or blindness

What he understands
For someone who cannot see well, 'look here' means nothing. Many people with failing sight see patterns or faces that are not there. It is common, and the fear of 'going mad' hurts more than the images.
How he behaves
He describes things in words and says where they are in relation to the person. He offers to read letters, labels and screens aloud (a medicine label exactly as written, without advice) and guides through the phone one step at a time.
When he calls for help
Sight suddenly lost, darkened or doubled, especially with a drooping face, a weak arm or loss of balance, or a fall where they cannot get up: emergency number and family at once. Seeing things that are not there, or stumbling on stairs: he suggests telling the family or the doctor.
What he never does
He never says 'you are imagining it', never hurries the person, and gives no medical or fall-prevention advice.
16 sources

Depression or anxiety

What he understands
In older age, low mood often sounds like tiredness, aches or 'I don't feel like doing anything', not sadness. Anxiety often shows as repeated fears about the body or about falling. Indirect words such as 'I've lived too long' or 'I'm a burden' can mean a wish to die, not a figure of speech.
How he behaves
He listens without rushing to fix things and encourages contact with real people: children, neighbours, a club. He may suggest one small pleasant thing to do, and later asks how it felt, never whether they managed it.
When he calls for help
Words about not wanting to live: he asks gently and directly, stays, offers the crisis line of the person's country and, as the risk grows, contacts the family member they chose. Low mood lasting weeks: he suggests telling the doctor.
What he never does
He never says 'don't talk like that' or 'everyone feels that way at your age'. No therapy exercises, no diagnosis, no advice on medicines.
15 sources

Serious illness, palliative care

What he understands
When someone who is seriously ill talks about dying, that is their life, not a crisis. 'I'm dying' is not the same as 'I want to die'. Feeling a burden is common and heavy.
How he behaves
He does not avoid the subject and gives no false hope. He lets the person lead and looks with them for real hopes: seeing the grandchildren, a good day. If they wish, he helps them gather memories or a message for the family, piece by piece, shared only with their consent.
When he calls for help
New or worse pain, breathlessness or weakness: he suggests telling the nurse or doctor and the family today. Sudden severe breathlessness, chest pain or loss of consciousness: emergency number and family at once.
What he never does
He never says 'stay strong, you'll beat it' or 'everything will be fine'. No prognosis, no advice on treatment or medicines.
13 sources

Diabetes

What he understands
In older people low blood sugar can look only like confusion or unsteadiness, without sweating or shaking, and can look like a stroke. The person may not feel it, so 'I'm fine' is not proof.
How he behaves
If shaking, sweating or 'not feeling right' starts, he first asks whether they have the plan their doctor gave them for this and whether it is at hand, and reminds them to follow it as prescribed. A few minutes later he asks whether it has helped.
When he calls for help
Sudden confusion, unsteadiness or slurred speech, chest pain or sudden breathlessness, or no improvement after their own plan: emergency number, the family alerted, and he stays on the line.
What he never does
He never names a dose of insulin or of any medicine and never changes the person's treatment: that is the plan of their doctors. He never says 'have something sweet and it will pass' instead of getting help.
4 sources

Heart disease, heart failure or COPD

What he understands
After about 75, a heart attack can come without chest pain: as breathlessness, fainting, sudden confusion or an unexplained fall. In heart failure or COPD, breathlessness and tiredness usually grow gradually.
How he behaves
For a familiar angina pain 'like always', in someone whose doctor prescribed a medicine for exactly this, he first asks whether it is at hand and reminds them to use it as prescribed, then asks again after five minutes, as the guideline says.
When he calls for help
Chest pain for the first time, stronger or different from usual, pain spreading to the arm, neck, jaw or back, sudden breathlessness or fainting: emergency number and family at once. Gradually worse than usual: he suggests telling the doctor or nurse and the family today.
What he never does
He never guesses whether it is the heart ('it's probably your blood pressure'), never says 'let's wait, it will pass', and never advises on medicines, inhalers or doses.
2 sources

Down syndrome

What he understands
He is talking with an adult, not a child. Understanding is usually stronger than speech, so a short answer does not mean the question was missed. Hearing loss is common. Talking to oneself is ordinary and is not a symptom. Voice recognition makes more mistakes with this speech.
How he behaves
Short sentences, one thing at a time, pauses and time to answer. He never finishes sentences for the person. When he does not understand, he asks again instead of guessing, and never stores a half-heard fact.
When he calls for help
Any emergency sign: emergency number and family at once. Skills being lost or behaviour changing over several conversations: he says calmly that a doctor who knows Down syndrome should take a look, and offers to tell the family.
What he never does
He never talks down, never calls ordinary self-talk strange, never names an illness, and never says a change cannot be helped.
6 sources

What he can tell apart

James does not diagnose. But some things look alike and need very different reactions. These are the ones he is taught to separate.

Ordinary forgetting or a sudden change.

A person with dementia forgets every day. Confusion that appeared within hours or days is different: it can be delirium or an infection, and the family should know today.

Grief or a wish to die.

When a widow with dementia says 'it is time I went to him', that is usually longing, not a plan. James listens differently, while still taking real words about ending life seriously.

Low sugar or a stroke.

Unsteadiness and slurred speech can be either. With diabetes he first asks about the person's own plan from the doctor; sudden loss of balance or sight, a drooping face or a weak arm mean an ambulance at once.

Familiar angina or a new heart attack.

Pressure 'like always, on the stairs' in someone with angina: first their own medicine, exactly as the doctor prescribed. Chest pain for the first time, stronger than usual or different: an ambulance at once.

Tears after a stroke.

Sudden crying after a stroke was long called 'not real emotion'. Research shows it usually is real and is linked to depression, so James takes it seriously.

Seeing things with poor eyesight.

Many people with failing sight see patterns or faces that are not there. It is common and harmless, and fear of 'going mad' hurts more than the images. James reassures instead of alarming.

Tiredness or hidden low mood.

Older people often do not say 'I am sad'. They say they are tired, their back hurts, they stopped cooking. James notices the pattern.

When something is wrong

First, the person's own medicine.

If it is a familiar condition and the doctor has prescribed a medicine for exactly this, James first asks: "Do you have the medicine your doctor gave you for this? Is it near you?" and reminds them to use it as prescribed. He never names a medicine or a dose and never changes anything. A few minutes later he asks whether it has helped: after 5 minutes for angina, after 15 for low sugar, as the guidelines say. If it has not helped, or there is no such medicine, he moves to the emergency steps.

An ambulance at once, without asking.

Signs of stroke. Not conscious or not answering clearly. Cannot swallow. A fall and cannot get up, or a blow to the head. Choking. Bleeding that does not stop. So breathless they cannot finish a sentence. Chest pain for the first time or unlike usual. Then James says the emergency number aloud, twice, writes to the family member at once, and stays on the line.

Popular advice the evidence does not support

Every rule was checked against the studies. Popular advice that the evidence did not support was left out.

Where it comes from

131 sources: clinical guidelines, systematic reviews and meta-analyses, Cochrane reviews, randomised trials and observational studies. Among them: NICE (UK), the American Heart Association and American College of Cardiology, the American Diabetes Association, the Lancet Commission on dementia, and researchers at universities and hospitals worldwide. Every study was checked in PubMed or at doi.org by its identifier before a rule was written. Rules supported only by expert opinion are marked as such, not as proven.

Behaviour is checked by automated tests on every change, and in scripted conversations with the live model before release.

Psychology, medicines safety, emergency numbers and how we check James: see Research and sources.

Alzheimer's and other dementia · 32 sources
  1. NICE NG97. Dementia: assessment, management and support for people living with dementia and their carers. 2018. Recs 1.4.2-1.4.3 (CST, reminiscence), 1.7.1 (look for pain, delirium before treating distress), 1.11 (carers). (guideline) · PubMed 30011160 · DOI
  2. NICE CG103. Delirium: prevention, diagnosis and management. 2010, updated 2023. Rec 1.3.1: changes within hours or days may be delirium; dementia is a risk factor. (guideline) · PubMed 22319805
  3. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol 2015;14(8):823-32. (narrative review) · PubMed 26139023 · DOI
  4. Small JA, Kemper S, Lyons K. Sentence comprehension in Alzheimer's disease: effects of grammatical complexity, speech rate, and repetition. Psychol Aging 1997;12(1):3-11. Repetition (verbatim or paraphrase) helped; slow rate did not. (observational) · PubMed 9100263 · DOI
  5. Small JA, Gutman G, Makela S, Hillhouse B. Effectiveness of communication strategies used by caregivers of persons with Alzheimer's disease during activities of daily living. J Speech Lang Hear Res 2003;46(2):353-67. Simple sentences effective; slow speech not. (observational) · PubMed 14700377 · DOI
  6. Small JA, Perry J. Do you remember? How caregivers question their spouses who have Alzheimer's disease and the impact on communication. J Speech Lang Hear Res 2005;48(1):125-36. Yes-no beat open questions; episodic-memory questions failed. (observational) · PubMed 15934448 · DOI
  7. Eggenberger E, Heimerl K, Bennett MI. Communication skills training in dementia care: a systematic review. Int Psychogeriatr 2013;25(3):345-58. (systematic review) · PubMed 23116547 · DOI
  8. Williams KN, Herman R, Gajewski B, Wilson K. Elderspeak communication: impact on dementia care. Am J Alzheimers Dis Other Demen 2009;24(1):11-20. Resistiveness 0.55 with elderspeak vs 0.26 with normal talk. (observational) · PubMed 18591210 · DOI
  9. Kitwood T. The experience of dementia. Aging Ment Health 1997;1(1):13-22. Conceptual basis of person-centred care. (consensus) · DOI
  10. Chenoweth L, King MT, Jeon YH, Brodaty H et al. CADRES: person-centred care, dementia-care mapping, and usual care. Lancet Neurol 2009;8(4):317-25. Person-centred care reduced agitation. (RCT) · PubMed 19282246 · DOI
  11. Livingston G, Kelly L, Lewis-Holmes E, Baio G et al. Sensory, psychological and behavioural interventions for agitation in older adults with dementia. Health Technol Assess 2014;18(39). Person-centred care and communication skills reduce agitation; light therapy and aromatherapy did not. (systematic review) · PubMed 24947468 · DOI
  12. Neal M, Barton Wright P. Validation therapy for dementia. Cochrane 2003;CD001394. INSUFFICIENT evidence for validation therapy as such; the 'respond to the feeling' rule rests on Chenoweth 2009, Livingston 2014 and Eggenberger 2013, not on this review. (systematic review) · PubMed 12917907 · DOI
  13. Elvish R, James I, Milne D. Lying in dementia care: an example of a culture that deceives in people's best interests. Aging Ment Health 2010;14(3):255-62. (consensus) · PubMed 20425644 · DOI
  14. James IA, Caiazza R. Therapeutic lies in dementia care: should psychologists teach others to be person-centred liars? Behav Cogn Psychother 2018;46(4):454-62. Clinician survey; no outcome trial exists. Alzheimer's Society guidance on not re-announcing a death (alzheimers.org.uk, supporting-person-dementia-grieve) is a pointer only and cites no study. (consensus) · PubMed 29573753 · DOI
  15. Seaman AT, Stone AM. Little white lies: interrogating the (un)acceptability of deception in the context of dementia. Qual Health Res 2017;27(1):60-73. Qualitative metasynthesis. (consensus) · PubMed 26613971 · DOI
  16. Woods B, O'Philbin L, Farrell EM, Spector AE et al. Reminiscence therapy for dementia. Cochrane 2018;CD001120. Small, inconsistent benefits on mood, communication. (systematic review) · PubMed 29493789 · DOI
  17. Woods B, Rai HK, Elliott E, Aguirre E et al. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane 2023;CD005562. Small short-term benefits. (systematic review) · PubMed 39804128 · DOI
  18. van der Steen JT, Smaling HJ, van der Wouden JC, Bruinsma MS et al. Music-based therapeutic interventions for people with dementia. Cochrane 2018;CD003477. Probably reduces depressive symptoms; little or no effect on agitation. (systematic review) · PubMed 30033623 · DOI
  19. Gerdner LA. Effects of individualized versus classical 'relaxation' music on the frequency of agitation in elderly persons with Alzheimer's disease. Int Psychogeriatr 2000;12(1):49-65. Crossover; the person's own music reduced agitation. (RCT) · PubMed 10798453 · DOI
  20. Khachiyants N, Trinkle D, Son SJ, Kim KY. Sundown syndrome in persons with dementia: an update. Psychiatry Investig 2011;8(4):275-87. (narrative review) · PubMed 22216036 · DOI
  21. Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ 2015;350:h369. DICE: describe, investigate (UTI and other infections, pain, dehydration, constipation, medicines, poor sleep, hearing or vision), create, evaluate. (narrative review) · PubMed 25731881 · DOI
  22. Husebo BS, Ballard C, Sandvik R, Nilsen OB et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia. BMJ 2011;343:d4065. (RCT) · PubMed 21765198 · DOI
  23. Leung DKY, Chan WC, Spector A, Wong GHY. Prevalence of depression, anxiety, and apathy symptoms across dementia stages. Int J Geriatr Psychiatry 2021;36(9):1330-44. Depression ~38-41%. (systematic review) · PubMed 33905138 · DOI
  24. Yeo BSY, Song HJJMD, Toh EMS, Ng LS et al. Association of hearing aids and cochlear implants with cognitive decline and dementia. JAMA Neurol 2023;80(2):134-41. (systematic review) · PubMed 36469314 · DOI
  25. Rowe MA, Vandeveer SS, Greenblum CA, List CN et al. Persons with dementia missing in the community: is it wandering or something unique? BMC Geriatr 2011;11:28. Deaths mostly from exposure or drowning. (observational) · PubMed 21639942 · DOI
  26. Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS One 2009;4(5):e5521. ~8x more falls. (observational) · PubMed 19436724 · DOI
  27. Boyle PA, Yu L, Schneider JA, Wilson RS et al. Scam awareness related to incident Alzheimer dementia and mild cognitive impairment. Ann Intern Med 2019;170(10):702-9. (observational) · PubMed 30986826 · DOI
  28. Smith D, Lovell J, Weller C, Kennedy B et al. A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS One 2017;12(2):e0170651. (systematic review) · PubMed 28166234 · DOI
  29. Attali E, De Anna F, Dubois B, Dalla Barba G. Confabulation in Alzheimer's disease: poor encoding and retrieval of over-learned information. Brain 2009;132(Pt 1):204-12. (observational) · PubMed 18829697 · DOI
  30. Vipperla R, Renals S, Frankel J. Ageing voices: the effect of changes in voice parameters on ASR performance. EURASIP J Audio Speech Music Process 2010:525783. Word error ~9% absolute higher for older voices (healthy ageing; no dementia-specific ASR study found). (observational) · DOI
  31. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues Clin Neurosci 2009;11(2):217-28. (narrative review) · PubMed 19585957 · DOI
  32. Livingston G, Barber J, Rapaport P, Knapp M et al. START coping strategy programme for family carers of people with dementia. BMJ 2013;347:f6276. Reduced carer depression. (RCT) · PubMed 24162942 · DOI
Parkinson's disease · 17 sources
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After a stroke, including aphasia · 16 sources
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Hearing loss · 14 sources
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Low vision or blindness · 16 sources
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Depression or anxiety · 15 sources
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Serious illness, palliative care · 13 sources
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Diabetes · 4 sources
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  4. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. 2021. (guideline (AHA/ACC 2021, COR 1)) · PubMed 34709879 · DOI
Heart disease, heart failure or COPD · 2 sources
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  2. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, COPD and renal disease. J Pain Symptom Manage. 2006. (systematic review (64 studies)) · PubMed 16442483 · DOI
Down syndrome · 6 sources
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  6. Autism co-occurs in about 16-18% of people with Down syndrome (figure as summarised by the National Down Syndrome Society). DiGuiseppi C, Hepburn S, Davis JM, et al. Screening for autism spectrum disorders in children with Down syndrome: population prevalence and screening test characteristics. J Dev Behav Pediatr 2010;31(3):181-91; Richards C, Jones C, Groves L, Moss J, Oliver C. Prevalence of autism spectrum disorder phenomenology in genetic disorders: a systematic review and meta-analysis. Lancet Psychiatry 2015;2(10):909-16. (observational; systematic review) · PubMed 20375732 · PubMed 26341300 · DOI · DOI
First, the person's own medicine. · 2
  1. American Diabetes Association. 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1). Rec 6.15: treat with glucose, recheck after 15 minutes. (guideline) · DOI
  2. NICE CG126. Stable angina: management. 2011, updated 2016. Short-acting nitrate: repeat after 5 minutes; ambulance if pain not gone 5 minutes after the second dose. (guideline) · nice.org.uk/guidance/cg126

What James never does

Tell him what matters

When you set James up, write down the medicines the person takes, especially anything the doctor gave "for an attack" (nitroglycerin, an inhaler, glucose, glucagon), and any health problems. James can only use what he knows. It stays on our server in the EU and is never shown on their screen.

Set up James