Speech pathology after a dementia diagnosis

Communication impacts almost every part of a person’s life, from having a conversation with a friend, to following a recipe, to understanding and filling out forms. A speech pathologist can help after a dementia diagnosis, to assess and support a person’s communication skills. It is important for people living with dementia and their carers to understand what a speech pathologist does, how a speech pathologist might help you, and why you should seek help early after your diagnosis.

What is a speech pathologist?

A speech pathologist has expertise in assessing and treating communication disorders that can be associated with different types of dementia such as:

language (e.g., word finding difficulties, comprehension difficulties),
pragmatics (e.g, knowing what to say, when to say it, how to say it),
cognitive-communication (e.g., remembering what was said in a conversation, staying focused when reading a story),
speech (e.g., slurring or mumbling),
voice (e.g., hoarse, soft, or monotone voice), and
fluency (stuttering).

A speech pathologist also has expertise in assessing and managing swallowing disorders.

Depending where you live, you might find your local speech pathologist working in a hospital, outpatient clinic, residential aged care facility, or private practice. You can find a Certified Practicing Speech Pathologist in your area, via the Speech Pathology Australia website.

What’s involved in speech therapy?

Step 1: Your speech pathologist will get to know you, so they can deliver person-centred care. You should share your hobbies, interests, family, personality, and life history. This information will help your speech pathologist to tailor the service to you.

Step 2: Your speech pathologist will work with you to develop goals for the service. These will be very personal to you. Some examples:

To tell the hairdresser what haircut you want
To get more involved in group conversations
To read the newspaper and talk about current events
To get your ideas across more easily
To follow a baking recipe
To have better conversations with your spouse
To be prepared for future life and communication changes.

Goals like these are aimed at maximising your independence and your life participation.

Step 3: Your speech pathologist will work with you to achieve your goals. You could benefit from treatment, education, advice, and/or tools to support communication. It is up to you and your speech pathologist to decide how often you have appointments, for how long, and who is involved. (Funding might influence this too).

Why you should start speech pathology early

This all relates to the principles of neuroplasticity, in particular “use it or lose it”. Decades of research has proven the brain can change. A person can maintain or improve skills, through regular use. For anyone who learned to play piano as a child but didn’t continue as an adult, then discovered later in life that they were not very good at playing piano anymore, that’s “use it or lose it”! Relating this example to speech pathology after a dementia diagnosis, regular communication ‘practice’ means you will maintain your communication skills over time.

Your speech pathologist will help you to make the most of your strengths, and find ways to overcome communication barriers, to keep your communication skills strong.

Here are some examples of evidence-based treatment approaches to support communication in dementia:

Approach	Examples
Cognitive rehabilitation	Spaced retrieval training Discourse intervention Word retrieval therapy
Cognitive stimulation	Reminiscence therapy Montessori intervention
Compensatory strategies	Memory aids Life book Photo diary
Education and support	‘MESSAGE’ communication partner training Group and individual support sessions

How to get started with speech pathology

If you are noticing any communication changes, or if you just want to be proactive (remember, use it or lose it), you have three options:

Talk to your GP about a referral to a speech pathologist, through the Medicare-subsidised Chronic Disease Management (CDM) Your GP might recommend a speech pathologist, or you can find one on the Speech Pathology Australia website.
Talk to your aged care provider about a referral to a speech pathologist using your Home Care Package. Your case manager might recommend a speech pathologist, or you can find one yourself and request to see that therapist.
Refer yourself directly to a speech pathologist. You can contact your closest public outpatient speech pathology department, or you can find a private speech pathologist on the Speech Pathology Australia website. If you are referring yourself directly, you shouldn’t need a doctor’s referral.