Zheng Zhu

Jiaqing Wang, Zhongfang Yang, Xingyuan Zhu et al.

Background: LLMs enable patient-facing conversational agents, creating a pathway toward digital twins that capture older adults' lived experiences and behavioral responses across time. A central barrier is personality drift -- inconsistent trait expression across repeated interactions -- which undermines reliability of generated trajectories and intervention-response simulation in geriatric care. Objective: To develop ELDER-SIM, a multi-role elderly-care conversational platform for building personality-stable digital twin agents, and to propose a psychometric validation framework for quantifying personality consistency in LLM-based agents. Methods: ELDER-SIM was implemented via n8n workflow orchestration with local LLM inference (Ollama/vLLM), integrating (1) Big Five (OCEAN) trait specifications, (2) a Cognitive Conceptualization Diagram (CCD) grounded in Beck's CBT framework, and (3) a MySQL-based long-term memory module. Ablation studies across four conditions -- Baseline, +Memory, +CCD, and +LoRA (fine-tuned on 19,717 instruction pairs from CHARLS) -- were evaluated via Cronbach's $α$, ICC, and role discrimination accuracy. Results: Reliability was acceptable to excellent across conditions (Cronbach's $α$: 0.70--0.94; ICC: 0.85--0.96). Role discrimination improved from 83.3% (Baseline) to 88.9% (+Memory), 94.4% (+CCD), and 97.2% (+LoRA). CCD produced the largest consistency gain (mean $α$ 0.702$\to$0.892), while LoRA achieved the highest overall consistency ($α$ 0.940; ICC 0.958). Conclusions: ELDER-SIM provides a psychometrically validated approach for constructing personality-consistent elderly digital twin agents. Structured cognitive modeling and domain adaptation reduce personality drift, supporting reliable longitudinal simulation for elderly mental health care and reproducible in silico evaluation before clinical deployment.

Shuqi Yang, Mingrui Jing, Shuai Wang et al.

This study reviewed the use of Large Language Models (LLMs) in healthcare, focusing on their training corpora, customization techniques, and evaluation metrics. A systematic search of studies from 2021 to 2024 identified 61 articles. Four types of corpora were used: clinical resources, literature, open-source datasets, and web-crawled data. Common construction techniques included pre-training, prompt engineering, and retrieval-augmented generation, with 44 studies combining multiple methods. Evaluation metrics were categorized into process, usability, and outcome metrics, with outcome metrics divided into model-based and expert-assessed outcomes. The study identified critical gaps in corpus fairness, which contributed to biases from geographic, cultural, and socio-economic factors. The reliance on unverified or unstructured data highlighted the need for better integration of evidence-based clinical guidelines. Future research should focus on developing a tiered corpus architecture with vetted sources and dynamic weighting, while ensuring model transparency. Additionally, the lack of standardized evaluation frameworks for domain-specific models called for comprehensive validation of LLMs in real-world healthcare settings.