Functional Communication Assessment in Persons With Dementia: Wins, Gaps, and Challenges

Functional communication ability is fundamental to individual expression, social connection, maintaining relationships, autonomy, and quality of life for persons with dementia. As dementia progresses, cognitive-linguistic functioning declines with significant negative effects on functional communication. Evidence-based, person-centered assessment using varied approaches is a cornerstone of best practice for persons with dementia. Assessment may be standardized, nonstandardized, or dynamic; may rely on caregiver- and patient-reported measures; and incorporate real-time observations in naturalistic settings or environmental assessment. Much progress has been made in using impairment-based, activity-oriented, and participatory assessments of cognitive-communicative function in dementia while considering how to render assessment ecologically valid, least biased, and culturally responsive. This overview examines current functional communication assessment practices in dementia care, focusing on approaches that allow speech-language pathologists to assess communicative performance and variables that support communication, engagement, and quality of life. We explore the evolution of assessment approaches in dementia, persistent gaps, and challenges with conducting meaningful assessment across dementia stages.