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The Role of a Speech Pathologist in Alzheimer's Disease: A Guide for Families

Alzheimer’s disease (AD) is a syndrome that includes multiple deficits, not limited to memory impairment. Word finding difficulties, reading or writing difficulties may occur. Disturbances in executive function including planning, organizing and completing tasks are a common symptom of the disease. These deficits may affect a person’s social skills and occupational success. The early signs of dementia include frequent pauses to retrieve words or memories, forgetting recent events, mood swings and personality changes, difficulty performing simple, routine tasks like paying bills and dressing, getting lost in familiar places, repeating the same conversation over and over.

Early signs of AD often involve speech and language.

Word finding problems, difficulty reading and/or writing, understanding, maintaining back and forth dialogue during conversation, repeating ideas over and over again may occur. The person with AD may begin a thought and not complete it. There may be a change in talkativeness (less or more). Often there is a very literal interpretation of things said and a failure to recognize humor.

Person and Family Centered Care is at the heart Speech Pathology Involvement in AD

At the beginning and throughout the course of treatment, speech language pathologists (SLPs) share information about dementia with the individual and their family/caregivers. Person-centered intervention focuses on maximizing the individual’s ability to participate in meaningful activities (e.g., Bourgeois, 2015; Chapey et al., 2000; Hickey, Khayum, & Bourgeois, 2018). Person-centered communication goals can focus on making it easier for the person with AD to understand and express themselves as it relates to their activities and in their familiar environments. SLPs can help the family or the individual with AD determine what is achievable in terms of planning and organizing an activity, like cooking. SLPs can do this by teaching self-monitoring, and problem solving. If needed, use of alternative and/or augmentative methods to support communication may be introduced.

Family members and those who care for individuals with dementia are faced with challenges that can affect their own health and well-being (Gilhooly et al., 2016; Raggi, Tasca, Panerai, Neri, & Ferri, 2015; Snyder et al., 2015). Changes in communication functioning due to cognitive decline, together with behavioral changes, can have a significant impact on day-to-day interactions and can result in considerable frustration. SLPs work with families and caregivers to help them understand and manage these changes, minimize stress and frustration, and provide a supportive environment for the individual with dementia.Some helpful tips for communicating with a person with AD initiating or maintaining routines or roles in the individual’s living community. Don’t interrupt while they are speaking, and avoid criticizing, correcting or arguing. Give simple explanations. Start up a conversation about something the person can see or touch. Maintain good eye contact and allow plenty of time for the person to reply. The best thing that you can do to help the person with Alzheimer’s disease express himself or herself is to provide compassion and understanding, respect the individual and honor their world. 

These are helpful speech language terms to understand. You may hear your doctor or SLP use these when speaking about language symptoms in AD: 

Aphasia. This involves problems speaking, understanding, reading, writing, telling time, and/or using numbers. Often misunderstood, aphasia does not affect a person’s intelligence. The most common cause of aphasia is a stroke.

Agnosia. A neurological disorder that results in an inability to recognize objects (such as an apple or a key), persons, smells, or sounds despite normally functioning senses (such as visual or auditory).

Apraxia of speech. Speech difficulties arise from problems planning motor movements. It is caused by damage to the parts of the brain that are involved in speaking.

Executive function. A set of processes that all have to do with managing oneself and one's resources in order to achieve a goal. Executive functions help you manage life tasks of all types. For example, executive functions let you organize a trip, a research project, or a paper for school.


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