Balance Problems Associated with Alzheimer’s & Dementia: Causes & Solutions

Dementia and Balance Issues

The mental impact of dementia is the primary symptom most people associate with the disease. However, there can also be physical symptoms of Alzheimer’s disease and other dementias, most notably balance issues. These issues will require specific long-term care supports in the later stages of dementia, and they can serve as early warning signs of the disease when they first appear.

For many years, it was commonly believed that balance issues only appeared in people with mid- to late-stage Alzheimer’s disease or other dementias. Patients in the later stages are more likely to actually fall than those in the early stages, but there have been multiple studies in the last two decades that show balance issues start to appear earlier.

This 2013 study from Washington University in St. Louis concluded that early-stage Alzheimer’s is a risk factor for falls in older adults, and these falls might precede any noticeable mental changes. This 2016 study conducted at multiple universities found that adults in the very early stages of Alzheimer’s may have balance and walking difficulties, and that recognizing these problems early and treating them with therapy can slow the progression of the symptoms. And this 2016 study from the University of California at Irvine concluded that poor physical performance, including balance issues, in seniors age 90+ is associated with the onset of dementia.

Medications that Impact Balance

Many common medications taken by older people can cause dizziness or lightheadedness and contribute to an increased risk of falling. Check with a doctor about medications to see if loss of balance, or even vertigo, might be due to drug interactions rather than the sickness itself.

Medications that people with dementia take to relieve symptoms can also make balancing more difficult. Memantine, which has been shown to improve memory and attention in people with dementia, lists “dizziness” as a side effect.

It is also noteworthy that cochlear implants, small hearing aids surgically rooted inside the ear, have been shown to cause vertigo and dizziness. If your loved one has a cochlear implant, this might explain problems with balance.

Recognizing Balance Problems in a Loved One

These are some of the balance and mobility issues that people in the early stages of dementia may exhibit before they show any mental decline:

• Unsteady gait – A change in someone’s normal walking motion and stride is one of the first signs of mobility impairment and potential dementia. They might start shuffling or being more clumsy than usual.
• Slowness – An overall slowing of movement is another early sign of mobility issues. Seniors may take shorter steps and have difficulty turning on their heel and pivoting to turn. They might also assume a stooped posture as they move.
• Stiffness – Some people may experience body stiffness as an early symptom of dementia. This can lead them to walk with a limp or sit on strange positions.
• Inability to move – Seniors with dementia can often develop apraxia, which means they difficulty starting to move, like getting out of a chair or beginning to walk after standing still.
• Greater risk of falls – The chances of falling increase with dementia, and they keep increasing as the disease progresses and balance issues worsen. Falls can be dangerous for seniors because their bones are more brittle and liable to break, and it takes them longer to heal. Plus, any major fall that requires surgery could be life-threatening.

These kind of physical symptoms of dementia, like an unsteady gait or stiffness, are often “parkinsonisms.” This should not be confused with Parkinson’s disease, although people with Parkinson’s can also exhibit parkinsonisms. These symptoms can appear separately, but often they arrive all at once, which can be overwhelming and frustrating for seniors and their families.

If you notice a loved one exhibiting any of these parkinsonims, talk to their doctor to see if they should be seen for further evaluation. Before calling a doctor, however, it’s important to make sure the mobility issues being caused by something else, like medication, arthritis, an injury, etc.

There are also plenty of steps to take at home to help seniors with mobility issues stay safe, and maintain, or even improve, their balance.

Solutions for Balance Problems Associated with Dementia

Making the home safe for a dementia patient with balance issues is the first step families and caregivers can take. The first step for patients is to start doing exercises that will improve their balance, which is both an innate ability and a learned skill that can be enhanced with practice. There are also mobility aids seniors can use to help them navigate the home.

Make the Home Safer

• Continually pick up and put away any obstacles on the floor, like shoes or clothes, that your loved one may trip over or need to steer around.
• Remove throw rugs, or secure them with double-sided tape.
• Keep useful items within reach, so your loved one needn’t strain to reach or use a stepping stool.
• Install grab bars in the bathroom by the toilet and in the shower or tub.
• Keep the house well lit, even at night, so your loved one has an easier time seeing.
• Any staircase should have a handrail.
• Avoid slippers or shoes that have deep treads. Footwear with thin non-slip soles is best.

Balance Exercises

Exercise lowers anxiety and improves memory in people with dementia, so patients should stay as active as possible. The following low-impact exercises can specifically help improve balance:

Calf Raises

1. Have your loved one stand holding the back of a chair.

2. Lift the heels, raising them onto tiptoes as high as possible.

3. Return heels to the floor.

4. Repeat 10 times.

Straight Leg Raises

1. Have your loved one lie down on his or her back, with the lower back contacting the floor. A soft surface, like a yoga mat, is a good idea.

2. Bend one knee to about 90 degrees, keeping the other leg straight.

3. Lift the straight leg to about the level of the other bent knee.

4. Lower the straight leg.

5. Repeat 10 times, then switch legs and repeat.

Single Leg Stand

1. Have your loved one stand next to a chair, but only touch the chair if needed.

2. Lift one leg to stand on one foot.

3. Hold for 10 seconds and return the foot to the floor.

4. Repeat 10 times, and then do the same with the other leg.

Mobility Aids

Canes and walkers may help maintain balance and get your loved one with dementia more comfortable standing and walking, but there are important issues to consider before purchasing a mobility aid:

• Canes and walkers may increase the likelihood that someone with dementia will fall. That is because using one of these devices can be complicated. Walking and using a mobility aid simultaneously can feel like multitasking for a person who is not mentally equipped to multitask.
• It’s vital that you consult a doctor or physical therapist before purchasing a cane or walker because there are so many types. A person’s gait, balancing ability and grip strength must be considered when deciding which to choose.
• You need to monitor your loved one’s use of a cane or walker continuously, because as memory worsens it may become hard to remember the proper way to use the device.
• It can be difficult to get someone with dementia to use a new tool continuously.

If you’ve found the right mobility aid and need your loved one to use it consistently, consider the following tips:

• Keep the cane or walker nearby. Place it at your loved one’s bedside during sleeping hours.
• Choose a cane or walker that has an appealing color or design feature for your loved one.
• If your loved one is prone to misplacing a cane, choose one with a bright color that is easy to find.
• Be prepared to remind your loved one to use the cane or walker. You may need to offer frequent refreshers on how to use it.

Canes:

• They are more useful when a person favors one side.
• Have your loved one use the cane on the opposite of the difficult side.
• The cane’s height should be at about hip level. A raised shoulder during usage means it’s too high.
• Foam handles are better for people with weaker grips.
• A rubber tip provides traction. On ice, you need a special attachment that should be available to screw onto the cane’s tip.
• Mount a hanging hook at home, so the cane is stored off the ground and can’t trip anyone.

Walkers (and rollators):

• Supports half a person’s weight, distributed evenly through both arms.
• Walkers can come with seats if your loved one becomes tired easily.
• Walkers with wheels are called “rollators.” These are easier to turn, but your loved one must be able to apply a brake to prevent accidents.
• Never push someone seated in a rollator.