Memory problems and difficulty thinking are the side effects most commonly associated with Alzheimer’s disease and similar dementias, but loss of balance is a scary issue that caregivers should be prepared for, especially in later stages.
In earlier stages, or even before other dementia symptoms develop, losing balance while standing or walking can indicate an increased potential to develop Alzheimer’s. It may also be a sign that your loved one is suffering from a kind of dementia other than Alzheimer’s, like vascular dementia.
The part of the brain that controls body movements is the cerebellum, located near the back base of the skull. Diseases that affect the cerebellum are likely to affect balance, and certain types of dementia fit the bill. Vascular dementia, for instance, is different from Alzheimer’s disease because the illness is caused by a lack of blood flow carrying oxygen to the cerebellum. (Vascular dementia is also known as “multi-infarct dementia.”) Some people with vascular dementia will actually experience feelings of vertigo (the sensation of movement while holding still) before they have trouble with thinking and memory.
There is also a specific kind of Alzheimer’s, called “posterior cortical atrophy,” which targets the cerebellum and, as a result, affects balance. People with posterior cortical atrophy can lose their sense of knowing which direction is up, are more prone to dizziness, and may be frequently leaning to one side. (For more on PCA, see below.)
Loss of balance for people with the most common form of Alzheimer’s often comes in the late stages. As brain cells deteriorate and neural communication throughout the body worsens, someone in late-stage Alzheimer’s will typically have more difficulty seeing, processing information about the physical environment, and walking. All of these affect balance. A typical adjustment people make is to change their “gait,” or how they walk, so that they’re shuffling their feet instead of lifting them with each step. It is actually more difficult to walk this way, and a loss of balance and falls become more likely. This is why exercises like Tai chi, riding a stationary bike, or leg lifts (see below) are a good idea.
Many common medications taken by older people, like for blood pressure, cause dizziness or lightheadedness and can 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.
For a number of reasons, including difficulty communicating, someone with Alzheimer’s may not be able to tell you that balance is becoming a problem. Watch for these signs:
– Walking unsteadily
– Shuffling rather than lifting the foot while taking steps
– Shortened steps
– Bumping into things
– Stooped posture
– Turning via small steps, rather than by pivoting on heels
Balance issues in the early stages of Alzheimer’s disease is not normal. Someone with Alzheimer’s typically doesn’t experience difficulty staying upright until the later stages, when communication between brain cells has become so compromised that most basic physical actions, including things like swallowing, become harder.
If someone with Alzheimer’s exhibits trouble with balance in the early stages, this could indicate a rarer form of the disease. Posterior cortical atrophy (PCA), also called Benson’s Syndrome, is a variant of Alzheimer’s disease that disrupts the back of the brain, responsible for vision and coordination. PCA can develop earlier in a person’s life than typical Alzheimer’s, usually in the mid-50s or early 60s. The first symptoms are changes in vision, making tasks like reading a line of text more difficult. Spacial awareness, including the ability to judge distances, becomes compromised. Someone with PCA may not be able to tell if objects are moving or not, and distinguishing multiple objects at once can also become too hard. These symptoms may combine to put a person off-balance. About five percent of cases of Alzheimer’s are PCA.
It’s important to note, though, that studies have shown a mild difference in gait, or the ability to walk, for people who are in the early stages of Alzheimer’s. This is harder to spot, but someone with mild Alzheimer’s is slightly slower than normal. Identifying when someone who may be developing Alzheimer’s has slowed is useful for treatment because the earlier someone begins physical therapy to improve their gait, the more effective therapy is to help maintain balance.
Balance could be considered a skill, something your loved one can improve with practice. Below are tips to make balance problems less dangerous, and to improve the ability to move around more easily.
To make balance less of an issue, your loved one’s home should be as easy to navigate as possible. Try these steps:
– 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.
Exercise lowers anxiety and improves memory in people with dementia, so it’s important that your loved one be as active as possible in any stage. Almost any physical activity that gets a person moving is good for Alzheimer’s symptoms, but these low-impact workouts can particularly help improve balance, in part by strengthening leg muscles and maintaining bone density:
1. Have your loved one stand holding the back of a chair.
2. Lift the heels, raising up onto tiptoes as high as possible.
3. Return heels to 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.
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 actually increase the likelihood that someone with dementia will fall, because using one of these devices is more complex. Walking and using the mobility aid simultaneously can feel like multitasking for a person who is not mentally equipped to multitask.
– It is vital that you consult a doctor or physical therapist before purchasing a cane or walker, because there are many types. A person’s gait, balancing ability, and grip strength must all be taken into consideration 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 close. Place it at your loved one’s bedside during sleeping hours.
– Choose a cane or walker that has an appealing color or design feature.
– If your loved one is prone to misplacing a cane, choose one with a bright color that’s easy to find.
– Be prepared to remind your loved one to use the cane or walker, and you may need to offer frequent refreshers on how to use it.
– 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 tires 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.