American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)
RCSLT Clinical Guidelines: 5.10 Disorders of Mental Health & Dementia

Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the assessment and management of communication and swallowing in children and adults with mental health conditions, including dementia and psychiatric disorders. The target audience of this guideline is speech and language therapists. Levels of evidence are provided and defined as follows: Grade A evidence includes “at least one randomised controlled trial as part of the body of literature, of overall good quality and consistency” (p. 387) that addresses the specific recommendation. Grade B evidence includes “well-conducted clinical studies but no randomised clinical trials on the topic of recommendation” (p. 387). Grade C evidence indicates the absence of “directly applicable studies of good quality” and is from expert committee reports on opinions and/or clinical experience.

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Cognitive-Communication
        • A number of factors contributing to communication should be assessed (Grade B Evidence). Factors include attention/concentration, sensory impairment, mood/behavior, insight, memory, orientation, executive skills and perceptual/spatial abilities.
        • Individuals with dementia should be assessed in the following areas of communication: pragmatics and discourse, use of referents, topic repetition, paucity of speech, turn-taking, and topic maintenance.
        • Evaluation of other core communication skills include non-verbal skills, intelligibility, verbal fluency, sequencing, and comprehension (Grade B Evidence).
        • The communication environment should be assessed by the speech-language pathologist.
      • Swallowing
        • Individuals with dementia should be assessed for swallowing problems.
        • Assessment should include a detailed case history paying particular attention to sudden onset and weight loss. The effects of mood and behavior, environment, medication, attitude, posture and capacity for treatment should also be evaluated to determine impact on eating and swallowing (Grade B Evidence).
  • Treatment
    • Cognitive-Communication
      • Compensatory and Restorative Treatments - For moderate to advanced dementia, interventions should focus on facilitation of verbal and non-verbal communication skills using a variety of techniques such as life-history books, memory aids, reminiscence and SONAS conversation groups and sensory stimulation (Grade B Evidence).
    • Swallowing
      • General Findings - The speech-language pathologist will determine the appropriate behavioral strategies for safe oral intake and communicate recommendations to carers of individuals with dementia (Grade A Evidence).
  • Service Delivery
    • Format
      • Group-Based Treatment
        • Training should be offered on an individual or group basis (Grade C Evidence).
        • Group language stimulation may be used to stimulate communication (Grade C Evidence).
    • Provider
      • Caregiver-Administered Treatment - Interventions should also focus on caregiver education/counseling to establish communication expectation and strategies (Grade B Evidence). 

Keywords: Dementia

Access the Guideline

Added to Compendium: November 2010

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