Speech-Language Pathologist Interventions for Communication in Moderate–Severe Dementia: A Systematic Review Purpose The purpose of this study is to evaluate the evidence for direct and indirect interventions for communication in people with moderate–severe dementia. Method 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. ... Review Article
Review Article  |   May 03, 2018
Speech-Language Pathologist Interventions for Communication in Moderate–Severe Dementia: A Systematic Review
Katina Swan, Marie Hopper, Rachel Wenke, Claire Jackson, Tracy Till, and Erin Conway
 
Author Affiliations & Notes
  • Katina Swan
    Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
  • Marie Hopper
    Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
  • Rachel Wenke
    Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
    Gold Coast Health, Clinical Governance, Education and Research (Allied Health), Southport, Queensland, Australia
    School of Allied Health Sciences, Griffith University (Adjunct Appointment), Gold Coast, Queensland, Australia
  • Claire Jackson
    Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
  • Tracy Till
    Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
  • Erin Conway
    School of Allied Health, Australian Catholic University, Banyo, Queensland
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Katina Swan is now at the School of Occupational Therapy, Social Work, and Speech Pathology at Curtin University, Bentley, Western Australia
    Katina Swan is now at the School of Occupational Therapy, Social Work, and Speech Pathology at Curtin University, Bentley, Western Australia×
  • Correspondence to Rachel Wenke: Rachel.Wenke@health.qld.gov.au
  • Editor-in-Chief: Krista Wilkinson
    Editor-in-Chief: Krista Wilkinson×
  • Editor: Kristie Spencer
    Editor: Kristie Spencer×
  • Copyright © 2018 American Speech-Language-Hearing Association
Article Information
Special Populations / Older Adults & Aging / Normal Language Processing / Attention, Memory & Executive Functions / Review Articles
Review Article   |   May 03, 2018
Speech-Language Pathologist Interventions for Communication in Moderate–Severe Dementia: A Systematic Review
American Journal of Speech-Language Pathology, May 2018, Vol. 27, 836-852. doi:10.1044/2017_AJSLP-17-0043
History: Received April 4, 2017 , Revised October 2, 2017 , Accepted November 28, 2017
 
American Journal of Speech-Language Pathology, May 2018, Vol. 27, 836-852. doi:10.1044/2017_AJSLP-17-0043
History: Received April 4, 2017; Revised October 2, 2017; Accepted November 28, 2017

Purpose The purpose of this study is to evaluate the evidence for direct and indirect interventions for communication in people with moderate–severe dementia.

Method 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).

Results 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.

Conclusions 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.

Supplemental Material https://doi.org/10.23641/asha.5985241

Acknowledgments
This work was supported by the Gold Coast Hospital and Health Service (GCHHS) Allied Health clinical backfill funding scheme and the GCHHS Speech Pathology Service. The authors thank Sarah Thorning, GCHHS librarian, for the completion of the literature search. A review protocol was registered on PROSPERO (protocol number 2015: CRD42015030224).
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