Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with dementia. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), prevention and advocacy, and education, administration, and research. See ASHA's Scope of Practice in Speech-Language Pathology (ASHA, 2007).
Appropriate roles for SLPs include
- identifying risk factors for dementia, taking into account variability among individuals from different racial and ethnic backgrounds and culturally and linguistically diverse populations;
- providing prevention information to individuals and groups known to be at risk for dementia, as well as to individuals working with those at risk;
- educating other professionals, third-party payers, and legislators on the needs of persons with dementia and the role of SLPs in diagnosing and managing cognitive communication and swallowing disorders associated with dementia;
- educating caregivers about possible communication difficulties and providing strategies to facilitate effective communication;
- screening individuals who present with language and communication difficulties, including hearing screening;
- determining the need for further assessment and/or referral for other services;
- conducting a culturally and linguistically appropriate comprehensive assessment across the SLP scope of practice, including assessment of cognitive-communication functioning and swallowing;
- diagnosing cognitive-communication disorders of dementia across the course of the underlying disease complex;
- assessing, diagnosing, and treating swallowing disorders associated with dementia;
- referring to an audiologist to rule out hearing loss and balance problems;
- referring to other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services;
- making decisions about the management of cognitive-communication deficits associated with dementia;
- developing treatment plans for maintaining cognitive-communication and functional abilities at the highest level throughout the underlying disease course;
- treating the cognitive aspects of communication, including attention, memory, sequencing, problem solving, and executive functioning;
- selecting culturally and linguistically appropriate techniques for direct intervention;
- gathering and reporting treatment outcomes;
- monitoring cognitive-communicative status to ensure appropriate intervention and support;
- providing indirect intervention through the individual's caregivers and environmental modification;
- providing counseling to persons with dementia and their families regarding communication-related issues and providing information about the nature of dementia and its course;
- consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate;
- remaining informed of research in the area of dementia and helping advance the knowledge base related to the nature and treatment of dementia;
- advocating for individuals with dementia and their families at the local, state, and national levels;
- serving as an integral member of an interdisciplinary team working with individuals with dementia and their families/caregivers;
- serving as a case manager, coordinator, or team leader to ensure appropriate and timely delivery of a comprehensive management plan;
- providing quality control and risk management.
As indicated in the Code of Ethics (ASHA, 2010), SLPs who serve this population should be specifically educated and appropriately trained to do so. Given the relationship between cognition and communication, practitioners who serve individuals with dementia require knowledge and skills in both areas, including specific knowledge of cognitive-communication disorders associated with dementia, to fulfill the aforementioned roles.
Most common dementia-associated diseases are progressive in nature, and SLPs have an ethical responsibility to provide appropriate services that will benefit the individual and maximize cognitive-communication functioning at all stages of the disease process.
SLPs collaborate with many other disciplines in caring for individuals with dementia. Referral and collaboration between members of the team, particularly during the assessment process and treatment planning, are important to help ensure quality service for individuals affected by communication and cognitive disorders. Coordinating assessment can prevent overlap in test selection. Ultimately, the focus of collaborative efforts must be on the clinical utility of information and how professionals with complementary knowledge and skills can affect functional outcomes for patients in a beneficial manner.