Dementia

Roles and Responsibilities of Speech-Language Pathologists

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, 2016b).

Appropriate roles for SLPs include the following:

  • 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
  • Screening individuals with cognitive-communication difficulties and determining the need for further assessment
  • Conducting a culturally and linguistically relevant comprehensive assessment of cognitive-communication functioning and swallowing
  • Diagnosing cognitive-communication disorders associated with dementia
  • Assessing, diagnosing, and treating swallowing disorders associated with dementia
  • Counseling persons with dementia and their families regarding communication-related issues and providing information about the nature of dementia and its course
  • 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
  • Developing treatment plans; providing treatment to maintain cognitive-communication and functional abilities at the highest level throughout the course of the underlying disease; and documenting treatment outcomes
  • Serving as an integral member of an interdisciplinary team working with individuals with dementia and their families/caregivers (see ASHA’s resources on interprofessional education/interprofessional practice [IPE/IPP] and person- and family-centered care)
  • Monitoring cognitive-communicative status to ensure appropriate intervention and support throughout the course of the underlying disease
  • Providing indirect intervention through the individual's caregivers and environmental modification
  • Consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development throughout the course of the underlying disease and to ensure continuum of care
  • Remaining informed of research in the area of cognitive-communication and swallowing deficits associated with dementia, and helping advance the knowledge base related to the nature and treatment of these conditions
  • Advocating for individuals with dementia and their families at the local, state, and national levels, and providing expert testimony when appropriate

As indicated in the Code of Ethics (ASHA, 2016a), 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 of the 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.

Interprofessional Collaboration

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—help ensure quality service for individuals affected by communication and cognitive disorders. Coordinating assessments can prevent overlap in test selection. Ultimately, the focus of collaborative efforts must be on the clinical usefulness of information and on how professionals with complementary knowledge and skills can affect functional outcomes for individuals. (See ASHA’s resources on IPE/IPP and person- and family-centered care.)

Roles and Responsibilities of Audiologists

Audiologists play a critical role in the assessment and care of individuals with dementia. The professional roles and activities in audiology include clinical services related to hearing loss (assessment, diagnosis, planning, and treatment); prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Audiology (ASHA, 2018).   

Appropriate roles for audiologists include the following:

  • Providing information to individuals and groups at risk for hearing loss and educating them on the link between hearing loss and dementia
  • Educating other professionals, third-party payers, and legislators on the needs of persons with dementia and hearing loss
  • Screening individuals with possible hearing loss and determining the need for further assessment
  • Conducting a comprehensive audiologic assessment and diagnosing hearing loss when present
  • Recognizing behaviors (e.g., cognitive and memory changes) associated with dementia and helping to determine if these behaviors may be related to the individual’s hearing loss
  • Screening for cognitive impairment (e.g., memory function) and determining the need for further assessment by an SLP and other professionals as appropriate
  • Counseling persons with dementia and their families regarding the impact of hearing loss on communication
  • Providing audiologic treatment to individuals with dementia that optimizes communication and social engagement throughout the course of the disease
  • Serving as an integral member of an interdisciplinary team to ensure comprehensive services and continuum of care for individuals with dementia and their families/caregivers (see ASHA’s resources on IPE/IPP and person- and family-centered care)
  • Providing indirect intervention through the individual’s caregivers, and recommending environmental modifications and other techniques to facilitate communication
  • Remaining informed of research in the area of hearing loss and dementia, and helping advance the knowledge base related to the nature and treatment of these conditions
  • Advocating for individuals with dementia and their families at the local, state, and national levels, and providing expert testimony when appropriate

As indicated in the Code of Ethics (ASHA, 2016a), audiologists who serve this population should be specifically educated and appropriately trained to do so. Given the relationship between hearing and dementia, audiologists who serve individuals with dementia require knowledge and skills in both areas as well as knowledge of cognitive-communication problems associated with dementia.

Most of the common dementia-associated diseases are progressive in nature, and audiologists have an ethical responsibility to provide appropriate services that will benefit the individual and maximize communication functioning at all stages of the disease process. 

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.