Speech Language Pathologist (SLP) to introduce MCI interventions?

@pb50 This is a great question. One of my friends saw an SLP for word retrieval and planning - referred to as executive function. This was at Emory University and she said that the strategies she learned have been very helpful for her.

Did your physician or a neurologist refer you to speech-language pathologist? Does the SLP work in a hospital or medical setting?

My first career was in speech-language pathology and I was on the faculty in that discipline in university for over two decades. A speech-language pathologist has taken courses in their graduate studies that pertain to cognitive-communication disorders (memory, thinking, planning) which includes the symptoms you described. The SLP also has clinical rotations in their studies that include working with patients with cognitive-communication disorders. Not every SLP specializes in working with MCI, dementia, or Alzheimer's disorders.

Have you asked the SLP you are working with about their background? Have they worked with other patients diagnosed with MCI? How many years of experience does this person have? These are the kinds of questions I have asked health care providers if the information isn't already displayed on a website.

If you don't feel you are making adequate progress or the SLP you are working with does not have the experience you would like then I think it's very reasonable to ask to see someone else.

I was referred to her by my neurologist. It’s a new service and I think she is the only one doing it in the rehab department.

She seems competent. I was tested a year ago by a neuropsych and while i had some gaps, it wasn’t saying Alzheimer’s yet. We have repeated a good bit of that. But i have APOE 3/4 and blood work that also puts me at higher risk. Plus I have a profound family hx. So it’s coming down the tracks 🙂

I tend to be very candid when i am retrieving a word. And if it doesn't come to the surface quickly I substitute or describe- whatever seems appropriate . But I am not trying to mask what is happening. The SLP wants me to focus on flow of communication and substitute quickly. That’s just one simple example that suggests we may have a different concept. The rest of what we talked about was whether and what my processes are for ensuring I take my meds and make my appointments. I don't know. It just seems simplistic. My biggest issue is that she immediately booked 15 appointments and there are two a week. That seems intense. I will speak to her about that.

I had an early career in Neurophysiology and then 20 years in Banking Regulatory Compliance program design. I am pretty good at problem solving. But I will continue to give it the college try. And I really appreciate your input.

@pb50 There are a variety of strategies that one can use for word retrieval. In my opinion your strategy of work substitution or description sounds good to me.

It almost sounds to me that she doesn't know you and your skills well enough at this point to figure out what might work best for you. Instead of getting right to the "work" can you ask the SLP to get to know you better by asking you questions about you. What would she like to know? What do you do very well that has not changed over time? Do you continue to problem solve well? Your early career and then and your 20 years in Banking Regulatory Compliance program design is fascinating to me. Would you like to share more about that? What are your interests and hobbies? It would be best to include your interests and your preferences in the treatment objectives. Two times a week for how long each session? Yes, for outpatient treatment that does seem intensive to me but then I don't know. how these sessions are done on an outpatient basis these days. Scheduling you for all those sessions in advance does seem overwhelming. It's really up to you whether or not you want to go two times per week for 15 sessions.

These are my thoughts as they've occurred to me. I'm sharing the kind of information I shared with my students and how I worked with patients.

It's rather frightening to know about the APOE gene and your family history. It's good that you had thorough testing by a neuropsychologist.

What other things are you doing for yourself? Do you socialize with friends and family? Go for walks? Work out in the gym?

Hi Helen - sorry I missed this as I always enjoy chatting with you.

About 2/3 of the way through the scheduled appointments she cancelled the remaining ones, saying she didn’t believe there was anything else she could do for me. By training i am very organized, so beefing my tools up here and there wasn’t hard.

@pb50 Thank you for coming back and letting me know what happened with your appointments. Did you gain any new tools or skills from the SLP you saw? Given your training and your background I think you have many more tools than the SLP's "average" patient.

How are you doing emotionally?

I am ok - staying very focused on fighting against this effectively. I am also fighting a torn meniscus in my knee from my lower limb exercises. Aging sux 🙂

Her tools were pretty fundamental and I actually had already implemented many of the tools such as calendars and pill minders and such during my career - one less thing i needed to remember.

I did also go back after 20 months from first tests to repeat the neuropsych tests. I actually improved in a couple of tests and the neuropsych doc describes visuo-spatial as the primary weakness observed. She remains unconvinced she sees evidence of AD - genetics and lab work notwithstanding.

All very interesting but my family history and genetic test revealing the APOE4 gene and undeniable weakness in maintaining train of thought and word retrieval.

So i keep fighting. I am optimistic about Lithium Orotate. I am not satisfied with my neurologist and am looking for another one.

Other than that… LOL

@pb50 It's unusual to see improvement on neuropsychological tests when cognitive impairment is suspected. You still are the best judge of your own capabilities. It's very possible that the tests that were administered are just not sensitive enough to pick up what you observe in yourself. With your family history and positive APOE4 gene does not mean that you will 100% develop Alzheimer's disease. It does place you in that high risk range and it's evident that you are doing everything you can to minimize that risk.

Here are two articles I located on this topic:

Mayo Clinic: Alzheimer's genes. Are you at risk:

-- https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-genes/art-20046552

Stanford Medicine: A news article based on a published article in Aging & Geriatrics:

-- https://med.stanford.edu/news/insights/2025/09/rethinking-alzheimers-gene-variant-apoe4.html

Since you are dissatisfied with your neurologist it's good you are looking for someone else. Are you interested in looking for a neurologist who specializes in Alzheimer's disease at an academic medical center? This would be a neurologist who conducts research and publishes in that area as well as sees patients. That's what I would do.

And what else? You wrote: "Other than that"...your turn to keep up this conversation.

@naturegirl5
That is so helpful!! And I would love a neurologist or psychiatrist who specializes in AD such as you describe. I am only about 45 mins away from Duke and my primary doc here in Burlington is affiliated with Duke. I see him in a couple of weeks for my annual physical so I am going to request someone at Duke.

I am off to read the articles you provided! Thanks again…

@pb50 Oh, you are close to more than one academic medical center in the Research Triangle. That's so good. I'm glad you mentioned a psychiatrist or neurologist. I should have mentioned psychiatry as that's another specialty with research and clinical expertise in Alzheimer's disease.

Would you please let me know what you and your primary care doc decide? I'll check back in with you.

Absolutely. Happy new year!