Dementia on the Praxis SLP: Types, Assessment & Intervention

Dementia is a growing area of SLP practice and a reliable slice of the Praxis 5331. You need the major types by hallmark features, the SLP scope, and the evidence-based interventions ETS wants you to pick. Here's the focused review.

What the Praxis tests about dementia

• Major dementia types and their differentiating features.
• Cognitive-communication assessment.
• The SLP scope in a dementia care team.
• Evidence-based interventions: spaced retrieval, memory books, environmental modifications.
• Distinguishing dementia from delirium and depression.
• Counseling families and caregivers.
• Ethical questions about capacity, decision-making, and end-of-life care.

The four major dementia types

Alzheimer's disease (AD)

• Most common — roughly 60–70% of cases.
• Hallmark: gradual onset, prominent short-term memory loss early.
• Cortical. Word-finding difficulty, anomia, empty speech over time.
• Pathology: beta-amyloid plaques and tau tangles.
• Language: semantic and pragmatic deficits appear before motor speech.

Vascular dementia

• Second most common.
• Hallmark: stepwise decline linked to strokes or small vessel disease.
• Executive dysfunction often prominent early.
• Patchy deficits based on infarct location — may look like localized aphasia.

Lewy body dementia (LBD)

• Hallmark: fluctuating cognition, visual hallucinations, parkinsonism.
• Sensitive to neuroleptics — antipsychotic drugs can worsen symptoms.
• REM sleep behavior disorder often precedes cognitive symptoms.

Frontotemporal dementia (FTD)

• Younger onset — often 50s to early 60s.
• Two main variants:
  • Behavioral variant — disinhibition, apathy, loss of social awareness.
  • Primary progressive aphasia (PPA) — language decline as the earliest and most prominent symptom. Three subtypes: nonfluent/agrammatic, semantic, logopenic.
• Memory is often relatively preserved early, unlike Alzheimer's.

The differential trap the Praxis loves

• 65-year-old with memory loss → Alzheimer's.
• 70-year-old with stepwise decline post-stroke → vascular.
• 72-year-old with hallucinations and rigidity → Lewy body.
• 58-year-old with progressive word-finding decline → primary progressive aphasia (FTD).

Dementia vs. delirium vs. depression — "the 3 Ds"

• Delirium — acute onset (hours to days), fluctuating, attention deficit, often reversible (infection, medication).
• Dementia — gradual onset (months to years), progressive, memory prominent, generally irreversible.
• Depression (pseudodementia) — variable onset, "I don't know" answers, memory complaints often exceed measurable deficit, responds to depression treatment.

Praxis pattern: acute confusion in a hospitalized elder = delirium first, work-up before assuming dementia.

Assessment tools for cognitive-communication

• MMSE — Mini-Mental State Examination. Widely used screen; not sensitive to mild or executive deficits.
• MoCA — Montreal Cognitive Assessment. More sensitive to mild cognitive impairment.
• SLUMS — Saint Louis University Mental Status exam. Similar sensitivity to MoCA.
• ABCD — Arizona Battery for Communication Disorders of Dementia. SLP-specific, comprehensive.
• CLQT — Cognitive Linguistic Quick Test.
• FLCI — Functional Linguistic Communication Inventory. Designed for moderate-to-severe dementia.

Evidence-based interventions

Spaced retrieval training (SRT)

Rehearse target information at progressively longer intervals. Strong evidence for teaching functional facts (own name, safety info, staff names). Works because it draws on procedural memory, which is often preserved even in moderate dementia.

Errorless learning

Structure trials so the client always produces the correct response — no guessing. Prevents encoding of errors. Pairs well with SRT.

Memory books, wallets, and aids

External memory aids with photos, names, and biographical facts. Reduce repetitive questioning and support autobiographical recall. Especially effective in moderate stages.

Environmental modifications

• Consistent routines and caregivers.
• Labeled drawers, signs, and clocks.
• Reduced clutter and noise.
• Simple, direct communication using short sentences.

Caregiver training

Teach caregivers strategies: yes/no questions, one-step directions, allow processing time, use written cues, avoid quizzing. Caregiver training is often the highest-yield intervention.

Communication strategies for staff and family

• Approach from the front, make eye contact.
• Use short, simple sentences.
• Ask one question at a time.
• Allow processing time — up to 30 seconds.
• Repeat, don't rephrase, if not understood the first time.
• Avoid open-ended questions ("What do you want for lunch?") in favor of choices ("Chicken or fish?").

Dysphagia in dementia

Feeding and swallowing safety become central in moderate to late stages. Key concepts:

• Feeding tubes do not extend life in end-stage dementia and often reduce quality of life. Hand feeding is the recommended standard when safe.
• Modified diets should balance safety and dignity. Least-restrictive appropriate texture.
• Aspiration risk increases with disease progression but may not always warrant NPO status — consider goals of care.

Ethical considerations

• Capacity vs. competency. Capacity is clinical, decision-specific, and can fluctuate. Competency is a legal determination.
• Advance directives. Ideally established early in the disease course while capacity is intact.
• Autonomy vs. safety. Balance respect for patient wishes with duty to prevent harm. Consult the ethics committee for hard cases.
• End-of-life discussions. SLPs are often present for hard conversations about feeding, communication, and hospice.

The Praxis answer pattern

On dementia items, the correct answer is usually the one that:

• Preserves function and dignity.
• Involves the family and caregivers.
• Uses evidence-based techniques (spaced retrieval, errorless learning, external aids).
• Considers safety without over-restricting.
• Respects patient autonomy where capacity is intact.

Wrong-sounding answers: aggressive drill therapy, requiring independent recall, ignoring family input, defaulting to feeding tubes or NPO without goals-of-care discussion.