Speech Therapy for Your Mild Cognitive Impairment (MCI)

Sometimes, mild cognitive impairment can interfere with your ability to communicate — for example, leaving you searching for a word, or making it harder to follow a conversation or storyline. If this happens, you may benefit from speech therapy.

• Losing your train of thought
• Not following the plot of a book or movie
• Having trouble following a conversation
• Difficulty finding the right word
• Other trouble with language, such as difficulty organizing words

“Changes in memory and communication skills are common early warning signs of mild cognitive impairment,” says Elizabeth Edgerly, PhD, a clinical psychologist who is the senior director of community programs and services at the Alzheimer’s Association. “If the person has mild cognitive impairment due to Alzheimer’s disease, these skills will worsen as the disease progresses.”

In some cases, Dr. Edgerly says, communication changes due to mild cognitive impairment may be less noticeable than in others. For example, a person might use more gestures instead of words, speak less in general, or use a smaller range of familiar words instead of a larger vocabulary.

Communicating effectively often means quickly learning and then remembering new information, such as what a person is telling you now or told you yesterday. In mild cognitive impairment, “There’s often subtle changes or frustrations in the area of short-term memory, especially if there’s been a delay from the initial presentation of that information,” says Erin Klein, a speech-language pathologist at Johns Hopkins Medicine in Baltimore.

Klein says that mild cognitive impairment can also reduce mental flexibility, in skills such as problem solving or figuring out new ways to do something. That can make it more difficult to communicate about new topics or in unfamiliar situations, and may contribute to difficulty using less-familiar words.

Speech therapy can be helpful for many people with mild cognitive impairment, although you shouldn’t expect it to solve or “cure” a person’s difficulties with communicating.

“Speech therapy, especially in the early stages of mild cognitive impairment, can help identify specific communication challenges and offer coping strategies that may help,” says Edgerly. “The goal of therapy is to help individuals preserve communication abilities, support cognitive function, and maintain independence for as long as possible.”

A speech therapist may use many different techniques to assess, and then try to improve, difficulties with communication.

“We first want to know, what’s important to the patient? What are they specifically having difficulties with?” says Klein. Then, she says, formal assessments may be used to get a better picture of the person’s cognitive and communication abilities.

As part of treatment, “We may lead the patient in specific exercises to engage an underlying cognitive skill,” says Klein. That could include exercises focused on immediate memory, delayed memory, or organization. “After that exercise, I like to allow the patient an opportunity to reflect on what went well, what didn’t go well, and how to make improvements. And that can build metacognitive awareness, our ability to think about our thinking.”

Awareness of how you think, Klein says, can help people with mild cognitive impairment activate support strategies that they develop with their speech therapist, such as mental checklists to help remember things or using external reminders like cards or notes. “Strategies will be identified as they’re appropriate for each patient, depending on what’s safe and attainable for them,” she says.

Speech-language pathologists don’t focus only on helping with communication. “We want to address the whole person, not just one skill at a time,” says Klein. That means your treatment plan may include strategies to help with daily activities, such as memory aids, calendars, alarms, and tools to help with food preparation or medication management.

If you think speech therapy could be helpful for you, the first step is usually to talk with your doctor about it. “In most cases, your primary care provider or neurologist can make a referral to a speech-language pathologist who specializes in cognitive-communication disorders,” says Edgerly.

Don’t let any worries that your difficulties could be too minor or trivial stop you from seeking help — especially since speech therapy may be more effective in the earlier stages of cognitive decline.

“We receive referrals for patients at various stages of cognitive ability,” says Klein. “They might have just noticed some subtle changes, or they may have been having difficulty for a few years.”

To prepare for your visit with a speech therapist, Edgerly recommends writing and bringing along a list of challenges you’re experiencing, with specific examples. And if you can, “Bring a family member or trusted friend to help take notes and reinforce follow-up care, since memory issues are common with mild cognitive impairment,” she says.

While speech therapy can help with communication challenges, lifestyle measures are also important for people with mild cognitive impairment and could even help with communication.

Sometimes, people with communication difficulties may be inclined to withdraw from conversations or social situations. But this usually isn’t good for the person’s communication skills or overall well-being.

“Individuals living with mild cognitive impairment can still participate in meaningful conversations,” says Edgerly. But it’s important for people around them to help facilitate participation. “Communication with a person with mild cognitive impairment requires patience, understanding, and good listening skills,” she says.

Klein often discusses lifestyle measures to help support cognitive health with her patients. “We talk about nutrition, physical activity, restorative sleep, social engagement, stress management, and mindfulness practices,” she says.

Physical activity may be particularly important, Klein says, by increasing blood flow to the brain, helping to reduce various sticky proteins, and aiding cognitive function. But it’s important to find an activity that fits a person’s preferences and any physical or safety-related constraints.

• Challenge your mind, such as with puzzles or activities.
• Get regular physical activity.
• Eat healthy foods, including vegetables and lean protein sources.
• Protect against head injuries, such as through steps to prevent falls.
• Don’t smoke.
• Keep blood pressure controlled.
• Manage diabetes if you have it.
• Maintain a healthy body weight.
• Get enough quality sleep, and treat any sleep disorders like sleep apnea.

Whenever possible, it’s important to navigate the challenges of mild cognitive impairment with other people actively involved.

“Living with cognitive impairment can be socially isolating,” says Edgerly. “It’s important for family members and friends to stay engaged with the person even as communication challenges become more severe. The best advice is to practice patience, offer reassurance, and tailor communication in ways that connect with the person.”

• Speech therapy may help those with mild cognitive impairment address specific communication challenges and improve daily interactions, although it isn’t a cure.
• Engaging in supportive lifestyle measures, such as regular physical activity and maintaining a healthy diet, can promote cognitive health and complement speech therapy.
• If you or your family notice that communication issues are impacting your daily life, seek early intervention to preserve communication abilities and learn workarounds.