Dementia and Related Memory Changes in Adults

Dementia and related memory disorders affect more than memory alone. Changes in communication, thinking, behavior, and swallowing are common and can significantly impact independence, safety, and quality of life. Speech-language pathologists (SLPs) play a central role in supporting individuals living with dementia and their care partners through education, practical strategies, and compassionate, evidence-based intervention.

Services are focused on preserving abilities, supporting meaningful communication, and improving day-to-day interactions, rather than attempting to “restore” lost skills.

Common Changes in Dementia and Memory Disorders

Cognitive-Communication Changes
Dementia often affects the thinking skills that support communication, including:

• Memory and recall

• Attention and processing speed

• Word finding and naming

• Understanding complex language

• Organization, sequencing, and problem solving

Individuals may repeat questions, lose track of conversations, struggle to find words, or become overwhelmed by too much information at once. These changes can lead to frustration, withdrawal, or increased dependence without appropriate support.

Communication and Interaction Changes
As dementia progresses, individuals may experience:

• Reduced initiation of conversation

• Difficulty expressing needs or preferences

• Changes in social communication and pragmatics

• Increased reliance on nonverbal communication

Supporting communication is essential for maintaining dignity, autonomy, and connection.

Swallowing Changes (Dysphagia)
Swallowing changes are common in dementia and may progress gradually. Difficulties may include:

• Reduced awareness of food in the mouth

• Difficulty chewing or coordinating the swallow

• Coughing, choking, or prolonged mealtimes

• Increased risk of aspiration and pneumonia

Dysphagia management in dementia requires a careful balance of safety, comfort, nutrition, and quality of life.

How a Speech-Language Pathologist Can Help

SLP services for dementia are individualized and stage-appropriate, with a strong emphasis on caregiver education and environmental supports.

Cognitive-Communication Support

• Preserve remaining skills through meaningful, functional activities

• Support comprehension and expression using simplified language and visual cues

• Improve participation in daily routines and social interactions

• Reduce frustration through environmental and communication modifications

Montessori-Based Dementia Care
Montessori-based dementia care focuses on strengths, independence, and purpose rather than deficits. This approach emphasizes:

• Using preserved abilities to support engagement

• Structured, predictable routines

• Hands-on, meaningful activities

• Environmental supports to reduce cognitive load

SLP services incorporate Montessori principles to promote autonomy, dignity, and connection at every stage of dementia.

Swallowing Evaluation and Management

• Assess swallowing safety and efficiency

• Provide strategies to support safe and comfortable eating

• Recommend modifications to pacing, posture, and environment

• Educate care partners on signs of swallowing decline and aspiration risk

• Support decision-making around feeding as dementia progresses

Care is guided by evidence, clinical judgment, and the individual’s values and goals.

Care Partner Coaching and Education

Care partners play a vital role in supporting individuals with dementia. Coaching and education are a central component of services and may include:

• Training in supportive communication strategies

• Guidance for managing challenging mealtime behaviors

• Education on expected changes and disease progression

• Counseling to reduce caregiver stress and burnout

• Support for advocacy and long-term planning

Empowering care partners improves outcomes for both the individual with dementia and those supporting them.

Specialized Expertise in Dementia and Dysphagia

In recognition of specialized expertise in swallowing disorders, the practice was recruited by Vanderbilt University researchers to contribute to a project focused on dementia and dysphagia. This work reflects a commitment to evidence-based care and advancing understanding of swallowing changes in neurodegenerative disease.

Supporting Dignity, Safety, and Connection

Speech-language pathology services for dementia focus on maintaining communication, safety, and quality of life for as long as possible. Therapy is grounded in respect, compassion, and collaboration, supporting both individuals and their care partners through every stage of the journey.