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Communication Disability in the Dementias



Communication Disability in the Dementias

Karen Bryan (Editor), Jane Maxim (Co-Editor)

ISBN: 978-0-470-03453-8 March 2006 354 Pages

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This book focuses on language and communication issues with older people with mental health problems. Radically revised and updated from the authors’ earlier book, “Communication Disability and the Psychiatry of Old Age”, this book recognizes that language and communication is not just the business of speech and language therapy but is relevant to all staff involved with people who have mental health difficulties. 

This book focuses on what older people with mental health difficulties require to maintain their independence and to minimize the effects of degenerative disease processes for as long as possible from a speech and language perspective.

  • Relevant to all members of the multidisciplinary team involved within older people’s mental health services
  • Each chapter is evidence-based and factual
  • Reflects the substantial advances in the diagnosis and treatment of dementias


Chapter 1: Health, ageing and the context of care (Karen Bryan and Jane Maxim).

Population issues.

Who are older people and where do they live?

Attitudes to older people and their health.

Overview of language and ageing.

Recent approaches to older people with dementia.

The evidence base for speech and language therapy intervention in dementia.

Services for older people.

Empowerment of older people.


Chapter 2: Mental health in older age (Claire Nicholl).


Service provision.

Evaluation of the older patient.

Classification of psychiatric illnesses.

Prevalence of psychiatric illness in older people.

Specific disorders.

Legal aspects.


Useful web sites.

Chapter 3: Managing dementias in primary care (Vari Drennan and Steve Iliffe).

The features of the dementias.

Recognition of dementia.

Disclosing the diagnosis.

Early interventions.

Gateways to support, information and services.

Joint working and people with a dementia.

Informal carers of people with dementia.

Caring for people at home as the dementia progresses.

Addressing the knowledge and attitudes of primary health-care professionals.

Primary health-care and care homes.

Outlining a framework for practice in primary health care.


Chapter 4: Language, communication and cognition in the dementias (Jane Maxim and Karen Bryan).

Why is an accurate diagnosis necessary?

Assessing communication in the dementias.

Aphasia and the dementias.

Alzheimer’s disease.

Vascular dementia (multi-infarct dementia).

Primary progressive aphasias, semantic dementia and Pick’s disease (frontotemporal dementia).

Dementia with Lewy bodies.

Huntington’s disease.

Parkinson’s disease.

Progressive supranuclear palsy.

Creutzfeldt–Jakob disease.

Depression, confusion and dementia.

HIV-associated cognitive impairment.

Dementia associated with alcoholism.

Down’s syndrome and dementia.



Chapter 5: Diagnosing semantic dementia and managing communication difficulties (Julie Snowden, Jackie Kindell and David Neary).

Introduction and overview of semantic dementia.

Overview of neuropathology.

Diagnosing semantic dementia.

Changes in behaviour.

Neuropsychological testing.

Managing communication difficulties in semantic dementia.

Learning and forgetting.



Chapter 6: Assessment of language and communication difficulties in the dementias (Susan Stevens).

The assessment process.

Assessing the dementias.

Assessing depression.

Late-onset schizophrenia and paraphrenia.

Alcohol abuse and related conditions (Wernicke–Korsakoff syndrome).

Dementia in Parkinson’s disease.

Down’s syndrome.



Chapter 7: Environmental and team approaches to communication in the dementias (Kate Allan).

Dementia, personhood and communication.

The development of interest in communication in dementia.

The idea of ‘person-centred care’.

Moving forward.

The environment and communication.

Designing environments for people with dementia.



Chapter 8: Speech and language therapy intervention for people with Alzheimer’s disease (Jackie Kindell and Helen Griffiths).

Working within a wider context.

Dementia care evaluation.

Validation therapies.

Multidisciplinary team working.

Presentation of language and cognition.

Role of the speech and language therapist.





Review and discharge.

The future.


Appendix 8.1: Questionnaires.

Appendix 8.2: Schedule of strategies to promote communication use by carers.

Chapter 9: Working with family and friends as carers (Colin Barnes).

Communication partners and carers.

Why work with carers?

Understanding informal carers.

The caring career.

Contact with carers and carer needs.

Interventions for carers.

Future developments and research.



Recommended resources for carers.

Chapter 10: Developing speech and language therapy services in older age mental health (Victoria Ramsey, Mary Heritage and Karen Bryan).

Speech and language therapy services in older age mental health.

Developing a new service.

Developing existing services.

Developing services in an environment of change.


Chapter 11: A survey of services for cognitively impaired elderly in the USA (Danielle Ripich and Jennifer Horner).

Dementia: demographics and costs.

Resources for elderly individuals.

Agencies and organizations.

Treatment and intervention for people with dementia.

Caregiver training programs.

How effective are interventions?



Governmental and professional dementia resources in the United States.

Chapter 12: Future directions (Jane Maxim and Karen Bryan).

Where are we now?

A service agenda for speech and language therapists.

Towards evidence-based practice.