As a speech therapy professional, you play a key role in managing dementia. Speech therapy can help patients improve safety, orientation, and quality of life.
In this article, you’ll learn all about speech therapy and dementia, including how to keep assessments and treatment meaningful and functional.
Your First Patient With Dementia: What To Expect
Dementia is an umbrella term for a group of symptoms, including memory loss, that are severe enough to interfere with the ability to do daily activities and care for oneself.
Types of dementia include Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia.
Dementia is progressive, which means that, over time, it will cause ongoing damage to the brain, and the symptoms will get worse.
Dementia typically involves memory loss. However, symptoms vary depending on which parts of the brain are affected (Mayo Clinic, 2024). The Alzheimer Society has a great article about dementia symptoms and areas of the brain.
Over 55 million people worldwide are diagnosed with dementia. Alzheimer’s disease is the most common form and makes up around 60-70% of cases (World Health Organization, 2023).
When working with dementia, it’s important to remember that there’s only so much you can do within your scope of practice. Try to keep your assessment and treatments meaningful and functional.
Here’s how to do it!
Speech Therapy And Dementia Assessment
Focus your assessment on functional and meaningful measures.
This typically involves assessing swallowing abilities, screening cognition and language, and supporting cognitive and/or language deficits with compensatory strategies and caregiver education.
More Popular Articles:
1. Chart Review
As you complete your chart review for a patient with dementia, also look for:
- Severity and type of dementia
- Any swallowing, language, and/or speech deficits
- Their abilities to complete ADL’s and IADL’s
- Their ability to participate in functional activities
- Current living situation (home with support, assisted living, group home, etc.)
- History of or acute behavior challenges (i.e., anxiety, agitation)
2. Interview The Patient AND Caregiver
Depending on the stage of their dementia, your patient may have mild to severe difficulties participating in the assessment. It’s best to have a caregiver or family present whenever possible.
During your interview:
- Confirm the patient’s name and date of birth on their admission bracelet (if they have one) and ask how they want to be addressed.
- Verify details of their medical history, current living situation, and daily routine.
- Explain the reason for your assessment and what the assessment will look like.
- Check if they are experiencing any difficulties swallowing.
- Ask what foods they like/dislike and about their current diet.
- Check for a history of pneumonia or weight loss.
- Ask the caregiver about the patient’s caregiver and/or family support. What do caregiver(s) report as their greatest challenges before admission?
- Check their independence levels before admission, including participation in independent activities of daily living (medication management, finances, etc.) and activities of daily living (getting dressed, toileting, bathing).
3. Complete An Oral Motor Examination
If your patient with dementia has signs of swallowing difficulties, complete an oral motor examination (OME). If their ability to participate is limited due to behavioral challenges, simplify your OME by modeling and increasing cues as needed.
4. Screen And/Or Assess For Dysphagia
We highly recommend screening and/or assessing for dysphagia in patients with dementia.
If the patient has a swallowing evaluation order or their chart review has dysphagia red flags like pneumonia secondary to aspiration, complete a full clinical swallow examination.
If not, screen with a 3-ounce water test (i.e. Yale Swallow Protocol) plus an oral motor examination.
5. Complete Additional Screens
Brief cognitive tests/screens can distinguish Alzheimer’s dementia or mild cognitive impairment from normal cognition (Agency For Healthcare Research And Quality, 2024).
These screens can also identify strengths and weaknesses in cognition and language. Plus, they can help you identify useful compensatory strategies.
The Montreal Cognitive Assessment, or “the MOCA”, is a common screen used as a brief cognitive test in patients with dementia. Here’s a link!
6. Make Recommendations & Educate
After completing the needed assessments and screens, you’ll educate your patient and their caregivers.
Explain how dementia can affect swallowing, cognition, and daily safety. Give your recommendations for speech therapy and offer helpful strategies.
Visit our shop for premade materials, handouts, and illustrations for your speech therapy treatment.
7. Make Referrals
Your patient may benefit from referrals to other providers to support their medical needs outside of your scope of practice.
Here are common referrals for your speech therapy patients with dementia:
- Physical therapy for mobility, balance, caregiver support
- Occupational therapy for ADL’s, IADLs, feeding, caregiver support
- Psychology/psychiatry for mental health management
- Dietitian for nutrition and hydration
- Neurology for diagnostics, behaviors, and medication management
- Urology for incontinence
8. Speech Therapy And Dementia Treatment
Keep your speech therapy dementia treatment functional, meaningful, and within your scope of practice. This means focusing primarily on compensatory strategies and caregiver training for carryover.
Evidence-based dementia and dysphagia treatments include oral hygiene, compensatory strategies, spaced retrieval, and/or diet modifications.
For cognitive-communication treatment, take advantage of their remaining strengths and skills. With dementia, this usually includes reading, procedural memory, and motor learning.
Research has shown that external memory aids are a practical and effective way to support patients with memory deficits. They can orient, remind, and help patients gain independence.
Cognitive training and group cognitive stimulation therapy can improve cognition in some patients with mild-to-moderate dementia (Livingston et al., 2020).
Reminiscence therapy has also been shown to improve quality of life, levels of depression, and overall cognitive function (Saragih et al., 2022).
For more treatment ideas, read Dementia Treatment In Speech Therapy.
Speech Therapy And Dementia Materials
Visit our shop for speech therapy materials designed for people with dementia and other common diagnoses.
The Adult Speech Therapy Roadmap course is a step-by-step guide to doing the job of adult speech therapy. Perfect for new grads or clinicians transitioning from pediatrics.
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
Adult Speech Therapy Roadmap Course
The Adult Speech Therapy Roadmap is an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy, from Day 1 to Discharge.
References
- Agency for Healthcare Research and Quality. (2022). Systematic Review: Diagnosis and Treatment of Clinical Alzheimer’s-Type Dementia. Effective Health Care Program. Retrieved January 2025 from https://effectivehealthcare.ahrq.gov/products/alzheimers-type-dementia/research
- Benigas, J.E. (n.d.) External Memory Aids and Memory Books for Memory Loss. Medbridge. https://www.medbridge.com/course-catalog/details/external-memory-aids-and-memory-books-for-memory-loss-jeanette-benigas/
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., Orgeta, V., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet (London, England), 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
- Mayo Clinic. (2024). Dementia. Retrieved Jan 2025 from https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013
- Saragih, I. D., Tonapa, S. I., Yao, C. T., Saragih, I. S., & Lee, B. O. (2022). Effects of reminiscence therapy in people with dementia: A systematic review and meta-analysis. Journal of psychiatric and mental health nursing, 29(6), 883–903. https://doi.org/10.1111/jpm.12830
- World Health Organization. (2023). Dementia. Retrieved January 2025 from https://www.who.int/news-room/fact-sheets/detail/dementia