Navigating Language in Dementia Care: Bilingualism, Communication, and the Untapped Potential of Speech-Language Pathologists

Aim: As the global population ages, the number of bilingual individuals living with dementia is increasing, yet their communication needs remain underrepresented in both clinical practice and research. This evidence review examines the intersection of language regression, communication challenges, and cultural–linguistic identity in bilingual dementia, with a particular focus on the role of speech–language pathologists (SLPs). Methods: Twelve peer-reviewed studies were critically reviewed and thematically analysed across four domains: (1) language regression and retention in bilingual dementia, (2) communication challenges in bilingual dementia care, (3) the marginal role of speech–language pathology, and (4) cultural–linguistic identity and health equity. The included studies span clinical case reports, experimental research, qualitative caregiver studies, and systematic reviews, with bilingual populations across Asia, Europe, North America, and the Middle East. Results: Findings reveal that language deterioration in bilingual dementia is dynamic and highly individualised, often influenced by language history, emotional context, and usage patterns. Caregivers and clinicians face persistent communication breakdowns, particularly in linguistically mismatched settings. Despite their specialised expertise in communication, SLPs remain largely peripheral in dementia care, constrained by systemic, educational, and methodological barriers. Moreover, linguistic and cultural identity play a critical role in how dementia is experienced and managed, yet are rarely integrated into care frameworks. Conclusions: This review highlights a significant knowledge–practice gap in bilingual dementia care and underscores the need to embed culturally and linguistically responsive communication practices, especially through speech–language therapy, at the centre of bilingual dementia care and support. It outlines key research and practice directions to advance equity, accuracy, and relational care in this growing population.