Speech-Language Pathologist Interventions for Communication in Moderate–Severe Dementia: A Systematic Review

Abstract

The purpose of this study is to evaluate the evidence for direct and indirect interventions for communication in people with moderate-severe dementia. A systematic search of the literature was conducted, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysed guidelines, across 8 electronic databases. Studies were included if they included direct or indirect interventions, which could be administered by a speech-language pathologist to people with moderate-severe dementia (defined as having Mini-Mental State Examination of ≤ 15; Folstein, Folstein, & McHugh, 1975). Studies also were required to include outcome measures, which reported on communication function or participation and/or well-being related to communication. Included studies were evaluated for methodological quality using the McMaster critical appraisal tool (Law et al., 1998). Eleven studies met the inclusion criteria. Ten of these studies related to direct interventions and included cognitive stimulation approaches using group (n = 5) or individual therapy (n = 1); cognitive training, including naming therapy (n = 1) and spaced retrieval training (n = 1); and cognitive rehabilitation approaches using augmentative and alternative communication (n = 2). One study reported an indirect intervention: conversation partner training. Due to the heterogeneity of studies, a meta-analysis was unable to be conducted. A descriptive synthesis of results indicated that interventions generally resulted in positive changes to communication and related quality-of-life outcomes compared with baseline or control groups. Preliminary evidence was found to support communication interventions for people with moderate-severe dementia. The use of cognitive stimulation approaches, which use a group treatment model and conversation, as a therapy medium show promise as direct intervention options. Implications for clinical practice for speech-language pathologists and future research are discussed. https://doi.org/10.23641/asha.5985241.