Cognition and Speech Therapy

National Better Hearing and Speech Month

In recognition of the American Speech-Language-Hearing Association’s designation of May as National Better Hearing & Speech Month, SALMON VNA speech department team members share some of the ways speech-language pathologists (SLPs) may help improve the health and communication of those they serve.


Oftentimes we will call a patient receiving VNA services to schedule an evaluation for speech therapy, and the patient will say, “Why? I speak fine!” Speech therapists work on a variety of skills – not just speech production. They also target language, swallowing, and cognition. In this article, we will focus on the positive effects a speech therapist may have on cognition, which is essential for being able to live at home and for sustaining one’s current living environment.

Speech therapists don’t only assist how you talk; they also:

  • Evaluate attention, concentration and reasoning.
  • Identify and treat swallowing problems.
  • Assess difficulty with word retrieval.
  • Create therapeutic exercises for brain health.
  • Help improve communication for people with dementia.

A cognitive disorder can range from a mild cognitive impairment to advanced dementia. Cognition includes areas of attention, concentration, orientation, word retrieval, and executive functioning skills such as problem solving and reasoning. There are normal age-related changes that occur, and part of a speech pathologist’s role is educating patients and families about typical versus atypical changes. For example, it is common for individuals to forget names of new acquaintances as they get older, but it is not typical for them to forget the names of familiar friends and family members. It is also common for individuals to have more difficulty multi-tasking as they age, but attention to one activity should be sustained. Once weaknesses are identified through evaluation, the speech therapist can set up a treatment plan that consists of therapeutic exercises (“brain workout”), compensatory strategies, and education to patient and caregivers.

Speech therapists can also provide differential diagnoses between a cognitive disorder and a language disorder. It is true that word retrieval can be affected by cognitive changes, but it can also be the result of a patient suffering from aphasia, which affects the production of words and language. A person with aphasia may seem to be confused because they cannot recall words or names of familiar people and places. For example, they may not be able to recall what they had for breakfast because they cannot think of the word “muffin.” It is important to differentiate these impairments in order to guide treatment strategies and lead to better outcomes for both patients and caregivers.

For individuals with advanced dementia, the speech therapist can play an important role. In home care, the goal is to sustain the individual’s current living situation, whether that is at home with a caregiver (husband, wife, child, 24-hour care) or an assisted living center. Challenges caregivers may face include communication breakdown, agitation, and resisting necessary procedures such as dressing, taking medications, and eating meals. At SALMON, the speech therapists are all Certified Dementia Practitioners. Our role is to identify strengths and highlight those strengths to compensate for the weaknesses. For example, a patient who is nonverbal due to dementia may still be able to read and respond to a written communication board. A patient who is agitated may need a visual representation of what will happen next to relieve stress and anxiety. Caregivers are then taught strategies that will ultimately improve their lives as well.

Speech pathologists are ready to help make life better for patients and their families. They’re also covered by Medicare.

With cognitive therapy, prognosis for improvement is strongly determined by the patient and caregivers’ motivation and participation. It is ideal to seek speech therapy at the first signs of cognitive decline. Remember, Medicare supports this therapy…Why? Because it works!

—Contributed by Jenn Eagerman, MS, CCC-SLP, and Kari Griffin MS, CCC-SLP, SALMON VNA & Hospice