Speech pathologists play a key role in dementia management. Speech pathology intervention in dementia includes treating speech, language, communication, cognitive, and swallowing disorders that arise across the progression of the disease. This evidence-based summary of dementia interventions was written by two speech pathology students on placement with Wollongong Speech Pathology: Clarisse Baker and Sarah DaCunha. This summary addresses treatments for people across all stages of dementia. It focuses on four main areas: cognitive rehabilitation, cognitive stimulation, caregiver training, and swallowing rehabilitation therapies.

Speech pathology intervention in dementia: 4 key approaches

What is “Cognitive Rehabilitation”?

Cognitive Rehabilitation

Cognitive rehabilitation can be restorative (increase function) or compensatory (support  current function).

What is “Cognitive Stimulation”?

Cognitive Stimulation

Speech pathology intervention in dementia where individuals participate in a range of enjoyable activities promoting socialisation.

What is “Caregiver Training”?

Caregiver Training

Caregiver education is an important part of speech pathology intervention in dementia. It involves the speech pathologist providing information, advice, and support to caregivers. This usually focuses on promoting positive communication.

What is “Swallowing Rehabilitation”?

Swallowing Rehabilitation

Speech pathology intervention in dementia might include swallowing. There are a wide range of swallowing difficulties that might present in dementia, from dribbling and chewing difficulties, through to choking.

Cognitive Rehabilitation

Cognitive rehabilitation is a type of speech pathology intervention in dementia that uses restorative and compensatory approaches. Cognitive rehabilitation is guided by an assessment of cognition (memory, attention, executive functions) and language (conversation, pragmatics) to identify areas for intervention.

Three main restorative approaches:

Spaced Retrieval Training is a restorative speech pathology intervention in dementia that aims to improve recall of facts and procedures. The person identifies a skill they’d like to improve. This is the “target”. Then in SRT, the “target” is recalled over increasing amounts of time, with repeated questioning or prompts. This speech pathology intervention in dementia promotes independence and improves communication (Jang et al., 2015).

Metacognitive Intervention is a restorative speech pathology intervention in dementia that aims to improve awareness of cognitive skills and how these impact communication. A person with dementia might find conversation hard due to memory, attention, or problem solving difficulties. In speech pathology, treatment might support a person to be more aware of these difficulties, and to use strategies to manage them better. This has positive effects towards increasing independence in the community and maintaining participation in daily activities (Terada et al., 2019).

Metalinguistic Intervention is a restorative speech pathology intervention in dementia aiming to improve speaking and understanding skills. Treatment might focus on words, grammar, and flow, and how to manage these better in everyday communication. This is a successful intervention, with evidence supporting an increase in skills with treatment (Rosell-Clari & Gonzalez, 2016).

Compensatory approach:

The use of memory aids is a compensatory speech pathology intervention in dementia. External memory aids aim to increase the independence of individuals with dementia by providing support for memory deficits. For example, a person might refer to a photo diary to start a conversation about a recent event. Or a person might have a structured shopping list, where groceries can be grouped together to support the person to remember the names of things they need to buy. Memory aids can improve relationships, social participation, and overall quality of life of both the individual with dementia and their significant others (Bourgeois, 2006; Nolan et al., 2001).

Examples of memory aids include:

  • Daily journals

  • Phone reminders

  • Calendar

  • Photo diary

  • Structured shopping list

  • Written routines

Cognitive Stimulation

In cognitive stimulation, individuals participate in a range of enjoyable activities that promote socialisation. These activities are mentally stimulating. They use active sensory engagement, thinking, concentration and memory (Woods et al., 2012).

Two main cognitive stimulation approaches:

This speech pathology intervention in dementia uses all senses (sight, touch, taste, smell, sound) to help recall memories. This could involve having a conversation, story telling, looking at photos or listening to songs. Creating life story books can be part of reminiscence therapy. A life story book might include important notes, letters and accomplishments of an individual’s life. They can improve the quality of life for people with dementia (Weise et al., 2018).

In a Montessori approach, we start by getting to know a person and their history and interests. The person then gets involved in doing activities that are of interest to them, and that have a purpose. For example, if a person is interested in reading, they might be involved in a roundtable reading group. Or if a person was interested in music, they might join a music group and sing along to the words and have conversations about music. Sorting and matching tasks are a common Montessori activity that can be helpful for maintaining language skills. For example, a person might sort music CD’s (before the music group) or count bingo chips (before a bingo activity).

Caregiver Education

Speech pathology intervention in dementia considers the family and caregivers who may be facing new challenges with their loved one. Changes in communication, personality, and behaviour can be a difficult adjustment. Offering knowledge, strategies, techniques, education, and training is successful in minimising caregiver’s stress, frustration and burden (Broughton et al., 2011).

The MESSAGE acronym (below) is a communication strategy that used by communication partners, such as family, friends or a partner when communicating with someone who has dementia. This ‘MESSAGE’ strategy is important to improve and maintain a person’s self-esteem and quality of life when living with dementia (Conway & Chenery, 2016).

MESSAGE:

M MAXIMISE attention
  • Attract attention
  • Avoid distractions
E EXPRESSION and body language
  • Be relaxed and calm
  • Show interest
S Keep it SIMPLE
  • Talk about short, simple and familiar topics
  • Offer clear choices and decisions
S SUPPORT their conversation
  • Be patient and help them to find the word
  • Repeat and rephrase
  • Provide reminders on the topic
A ASSIST with visual AIDS
  • Use gestures and actions to help clarify what you are saying
  • Use objects and pictures as well as speech
G GET their message
  • Listen, watch, and work out what they are trying to say
  • Look out for behaviour and nonverbal messages
E ENCOURAGE and ENGAGE in communication
  • Engage in interesting and familiar topics
  • Encourage conversation with family and friends
  • Respect – don’t ask testing questions or argue, instead acknowledge feelings and provide reassurance

Swallowing Rehabilitation

A person with dementia may have chewing and swallowing difficulties. A speech pathologist can assess a person’s eating and drinking skills, identify problems, and offer recommendations. Swallowing intervention can involve:

  • Swallowing rehabilitation: exercises that will help restore swallow function.
  • Compensatory techniques: positioning, equipment, and texture modification.
  • Mealtime management strategies: pacing strategies, cognitive strategies to help with memory.

Where can I find out more about speech pathology intervention in dementia?

To read more, take a look at these links:

References

  • Swan, K., Hopper, M., Wenke, R., Jackson, C., Till, T., & Conway, E. (2018). Speech-Language Pathologist Interventions for Communication in Moderate–Severe Dementia: A Systematic Review. American Journal of Speech – Language Pathology (Online), 27(2), 836-852. http://dx.doi.org.ezproxy.lib.uts.edu.au/10.1044/2017_AJSLP-17-0043
  • Hopper, T., Bourgeois, M., Pimentel, J., Qualls, C. D., Hickey, E., Frymark, T., & Schooling, T. (2013). An evidence-based systematic review on cognitive interventions for individuals with dementia. American Journal of Speech-Language Pathology, 22(1), 126–145. https://doi.org/10.1044/1058-0360(2012/11-0137)
  • Jang, J. S., Lee, J. S., & Yoo, D. H. (2015). Effects of spaced retrieval training with errorless learning in the rehabilitation of patients with dementia. Journal of Physical Therapy Science, 27(9), 2735–2738. https://doi.org/10.1589/jpts.27.2735
  • Nolan BA, Mathews RM, Harrison M. Using external memory aids to increase room finding by older adults with dementia. Am J Alzheimers Dis Other Demen. 2001 Jul-Aug;16(4):251-4. doi: 10.1177/153331750101600413. PMID: 11501349.
  • Bourgeois, M. S. (2006). External Aids. In D. K. Attix & K. A. Welsh-Bohmer (Eds.), Geriatric neuropsychology: Assessment and intervention (pp. 333–345). Guilford Publications.
  • Weise, L., Jakob, E., Töpfer, N. F., & Wilz, G. (2018). Study protocol: Individualized music for people with dementia – Improvement of quality of life and social participation for people with dementia in institutional care. BMC Geriatrics, 18(1), 313–313. https://doi.org/10.1186/s12877-018-1000-3
  • Terada, S., Nakashima, M., Wakutani, Y., Nakata, K., Kutoku, Y., Sunada, Y., Kondo, K., Ishizu, H., Yokota, O., Maki, Y., Hattori, H., & Yamada, N. (2019). Social problems in daily life of patients with dementia: Social problems in dementia. Geriatrics & Gerontology International, 19(2), 113–118. https://www.researchgate.net/publication/329419736_Social_problems_in_daily_life_of_patients_with_dementia_Social_problems_in_dementia
  • Rosell-Clari, V., & González, B. V. (2016). Theory of Mind (ToM) and language: stimulating metalinguistic skills in people with dementia. CoDAS (São Paulo), 28(3), 252–260. https://doi.org/10.1590/2317-1782/20162015295
  • MESSAGE and RECAPS strategies in dementia. Retrieved from https://static.cambridge.org/content/id/urn:cambridge.org:id:article:S1041610210001845/resource/name/S1041610210001845sup001.pdf
  • Conway, E. R., & Chenery, H. J. (2016). Evaluating the MESSAGE Communication Strategies in Dementia training for use with community-based aged care staff working with people with dementia: a controlled pretest-post-test study. Journal of Clinical Nursing, 25(7-8), 1145–1155. https://doi.org/10.1111/jocn.13134
  • Small, J. A., & Cochrane, D. (2020). Spaced retrieval and episodic memory training in Alzheimer’s disease. Clinical Interventions in Aging, 15, 519-536. http://dx.doi.org.ezproxy.lib.uts.edu.au/10.2147/CIA.S242113