According to World Health Organization (WHO), the prevalence of Dementia has reached 35 million cases worldwide. In the U.S., 5 million seniors over age 65 are currently living with dementia. Dementia also has a high incidence, with 7.7 million new cases diagnosed each year worldwide. This means that 1 in 10 of all seniors over the age of 65” will suffer from some form of dementia.
The role of a speech language pathologist (SLP) in assessing cognitive decline
Speech language pathologists (SLPs) assess, diagnose, and treat speech, language, swallowing, and cognitive disorders. According to ASHA (American Speech-Language-Hearing Association) report, out of their wide range of medical SLPs spend 15% of their time in practice treating dementia alone. In many medical facilities such as acute care hospitals, long-term care skilled nursing facilities, or private clinics, SLPs often receives referrals for patients who develop cognitive impairment such as deficits in attention, memory, organization and planning, reasoning and problem-solving, executive function, etc. Some of these patients may suffer from recent stroke or traumatic brain injury, some may have an unwitnessed fall at home, some may had decreased independence in managing their daily activities such as managing personal finances or medical appointment.
A cognitive evaluation or screening is often the first place where an SLP may noticed early signs of cognitive decline, using various assessment tools such as the Saint Louis University Mental Status (SLUMS) Exam, The Mini Mental State Examination (MMSE), and The Montreal Cognitive Assessment (MOCA), etc. The purpose of the evaluation is to assess the baseline severity of cognitive decline in various areas, set measurable and functional goals, and determine whether the current stage of cognitive decline may benefit from restorative or maintenance intervention to manage various diagnoses such as dementia vs. mild cognitive impairment (MCI) – a transitional diagnostic category between normal cognitive aging and dementia. Distinguishing MCI from normal aging and dementia can be difficult. Thus, SLPs will continue to play a primary and crucial role in the multidisciplinary team serving individuals with MCI and dementia.
In addition, SLPs also use their expertise to pinpoint specific dementia types (e.g., vascular dementia vs. frontotemporal dementia) to assist in differential diagnosis, since many other neurodegenerative diseases can present with early speech or language symptoms. If the SLP concludes that symptoms of cognitive decline present, the SLP will also alert the referring provider to ensure that an appropriate medical assessment (by neurology and neuropsychology) is in placed.
The Importance of Early Identification of Cognitive Decline
As a clinician who also worked with pediatric population for early intervention (between age 0-3 years old), I have witnessed the drastic impact and benefit of providing intervention early to yield a child’s speech and language development to meet his or her age-equivalent peers. However, such concept of early detection of cognitive impairment is often neglected in the geriatric population. Many people perceive “memory loss” as part of normal aging; however, many of these “myths” are not typical in normal aging minds.
A recent study in 2015 published in the Journal of the American Academy of Neurology investigated two thousand European-American and African Americans with an average age of 73 years old. The result indicated that some participants made errors on cognitive tests in areas of memory and thinking as early as 13-18 years prior to eventually being diagnosed with Alzheimer’s dementia. That yields possible sign and symptoms of cognitive decline as early 55-60 years old! Furthermore, those participants with lower test scores in the first year of the follow-up longitudinal triennial assessments were 10 times more likely to be diagnosed with Alzheimer’s than those with higher scores.
In sum, early detection is important; eSLUMS can help this process by removing barriers and making it easier and cheaper.
eSLUMS is an electronic version of the “Saint Louis University Mental Status” (SLUMS) Exam, a standardized assessment for evaluating cognitive status. Although this assessment is available to the public, many people suffering from dementia or cognitive impairment, as well as their family and friends, are not aware of these medical assessments and do not feel comfortable using them. ChewyLogic LLC created eSLUMS with a mobile and tablet version (read more “So What’s In A Name?”) to provide an easy tool for early assessment and detection of possible cognitive decline. We believe taking ownership of oneself is the best way to manage devastating disease such like dementia.