Dementia
Service Delivery

Provider

External Scientific Evidence

Evidence-Based Practice Guidelines

Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)   Royal College of Speech and Language Therapists Clinical Guidelines: 5.10 Disorders of Mental Health & Dementia Taylor-Goh, S., ed. (2005). RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd. Added: July 2011

 

Description

This guideline provides recommendations for the assessment and management of communication and swallowing in children and adults with mental health conditions, including dementia and psychiatric disorders. Separate recommendations specific to individuals with dementia are provided in one section of this review and are listed below. The target audience of this guideline is speech and language therapists. Levels of evidence are provided and defined as follows: Grade A evidence includes “at least one randomised controlled trial as part of the body of literature, of overall good quality and consistency” (p. 387) that addresses the specific recommendation. Grade B evidence includes “well-conducted clinical studies but no randomised clinical trials on the topic of recommendation” (p. 387). Grade C evidence indicates the absence of “directly applicable studies of good quality” and is from expert committee reports on opinions and/or clinical experience. 

 

Recommendations

Interventions should also focus on caregiver education/counseling to establish communication expectation and strategies (Grade B Evidence).

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Evidence-Based Systematic Reviews

Methods to Enhance Verbal Communication Between Individuals with Alzheimer's Disease and Their Formal and Informal Caregivers: A Systematic Review Egan, M., Berube, D., et al. (2010). International Journal of Alzheimer's Disease, 12 pages. Added: July 2011

 

Description

This is a systematic review of experimental studies investigating interventions that attempt to improve communication between individuals with Alzheimer’s dementia and their caregivers. The strength of the evidence is rated A, B, or C. Level A evidence is provided by systematic reviews or high-quality RCTs. Other types of studies that may have threats to internal validity provide Level B evidence. Level C evidence is supported by expert opinion. 

 

Conclusions

• Memory books with caregiver training: “Using the [Strength of Recommendation Taxonomy] SORT criteria… the use of memory aids with caregiver training would be recommended for use by clinicians with a rating strength of B. This rating is supported by results from two RCTs from which there were mixed results” (p. 5).
• Education and training: “Within these studies there was no firm support for intensive caregiver training, with the exception of individualized communication prescriptions. Overall, the strength of recommendation for this intervention was C, a result supported by one RCT” (p. 5).

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Evidence-Based Practice Recommendations: Caregiver-Administered Active Cognitive Stimulation for Individuals with Alzheimer's Disease Zientz, J., Rackley, A., et al. (2007). Journal of Medical Speech-Language Pathology, 15(3), xxvii-xxxiv.    Added: July 2011

 

Description

This is a review of quantitative studies pertaining to indirect interventions for individuals with Alzheimer's disease (AD). This review is part of a series of reports from the Academy of Neurologic Communication Disorders and Science specific to the assessment and management of individuals with dementia. 

 

Conclusions

• Results from 3 studies support the training of caregivers to provide cognitive stimulation therapy for individuals with mild to moderate Alzheimer's disease. However, methodological weakness of studies was noted.
• The authors of the review found active cognitive stimulation therapies to be beneficial in maintaining cognitive and behavioral function.
• Further research is warranted to determine the long term benefits of caregiver-administered treatment.

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Evidence-Based Practice Recommendations for Dementia: Educating Caregivers on Alzheimer's Disease and Training Communication Strategies Zientz, J., Rackley, A., et al. (2007). Journal of Medical Speech-Language Pathology, 15(1), liii-lxiv.  Added: July 2011

 

Description

This is a review of experimental and observational studies that investigated the effects of caregiver education and training on the communication functioning of individuals with Alzheimer's disease. This review is part of a series of reports from the Academy of Neurologic Communication Disorders and Science specific to the assessment and management of individuals with dementia. 

 

Conclusions

• The findings support the education and training of caregivers to provide communication strategies to individuals with Alzheimer's disease.
• Preliminary evidence suggests that caregiver training may be beneficial to enhance communication skills. Caregiver training may contribute to improved conversation, maintenance of language ability and quality of life for individuals with Alzheimer's disease.
• Caregiver education may contribute to reduced or increased caregiver burden.

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