What Stage of Dementia is Dizziness?

Dementia refers to a group of conditions that cause cognitive impairment (difficulty thinking and reasoning) and affect a person’s ability to socialize and perform necessary daily functions. Physical symptoms such as trouble balancing, dizziness, vertigo, and urinary or bowel incontinence may develop. Psychological symptoms, such as personality changes, agitation, hallucinations, and anxiety, may also occur, depending on the type of dementia that develops and its progression.

Symptoms are largely based on which part of the brain is most affected by dementia. For example, damage to the cerebellum — the main part of the brain that is responsible for balance — may be the contributing factor when people with dementia experience dizziness.

Dementia is subdivided into stages. In the early stages, symptoms are mild and may cause minor functioning problems. As the disease progresses to later stages, symptoms become more severe and prevent people from performing basic life activities, such as bathing or eating.

The most common type of dementia among older adults is Alzheimer’s disease. Other types of dementia include vascular dementia, frontotemporal dementia, Lewy body dementia, and mixed dementia. There is a potential for people with any form of dementia to experience dizziness, but the likelihood of this symptom occurring and its timing may differ based on the type of dementia.

Alzheimer’s Disease

Alzheimer’s disease is a progressive condition characterized by the accumulation of abnormal proteins in the brain that leads to the loss of neurons and decreased brain function. The exact cause of Alzheimer’s disease is unknown but is likely multifactorial, meaning it is caused by a combination of age-related changes, as well as genetic, environmental, and lifestyle factors.

Alzheimer’s is less likely than other degenerative brain diseases to cause balance issues, dizziness, or vertigo because it most commonly affects the brain’s cortex — the part of the brain that is responsible for higher-level functions, including decision-making, impulse control, memory, and personality. Furthermore, evidence suggests that the cortex plays a greater role in maintaining balance than previously believed due to its involvement in processing visual information. This connection could explain the potential for developing dizziness and other balance-related symptoms during Alzheimer’s disease and other cortex-based forms of dementia, such as frontotemporal dementia (FTD).

Research has also demonstrated a potential connection between frequently losing balance and the risk of developing Alzheimer’s later on in life, suggesting that the loss of balance could be one of the earliest signs of the disease for some people. However, in most cases, balance issues and dizziness develop in the later stages of Alzheimer’s. As more brain cells become damaged, basic functions such as walking, seeing clearly, and processing the environment become more difficult, making people feel dizzy and off balance.

A notable exception to this pattern is posterior cortical atrophy, a specific type of Alzheimer’s dementia. Balance difficulties are common for people with posterior cortical atrophy because this condition causes damage to the cerebellum. In Alzheimer’s and other types of dementia, these symptoms can also manifest as a change in gait or how a person walks. Typically, people who feel off balance will avoid lifting their feet while walking, resulting in a shuffling gait.

Gait changes can first indicate that someone is suffering from balance problems. Other signs of balance issues include walking unsteadily, bumping into objects, walking in shorter steps, sitting or walking in a stooped position, and turning in small steps. Loved ones should be diligent in watching for these signs, as people with Alzheimer’s and other forms of dementia can have trouble communicating what is bothering them.

Vascular Dementia

Vascular dementia is the second most common dementia type after Alzheimer’s, and it is caused by an accumulation of blood clots in the brain that reduce blood flow, causing brain damage and subsequent symptoms. As vascular dementia can affect the entire brain or parts of it, this form of dementia is more likely to cause dizziness and balance issues than other dementia (e.g., Alzheimer’s). As a result, when people with Alzheimer’s develop dizziness and balance problems, it is important to evaluate them for vascular dementia.

Blood clots can form in any part of the brain, and the symptoms differ based on which part of the brain is affected. Dizziness due to vascular dementia is most often noted when blood clots form in the cerebellum and can occur at any stage of illness, depending on the size and number of blood clots. Bleeding due to a ruptured blood vessel, such as from a stroke, may also cause vascular dementia.

Mixed Dementia

Mixed dementia is diagnosed when a person has symptoms of at least two types of dementia, and it is usually a combination of the most common types — Alzheimer’s disease and vascular dementia. Most people are diagnosed with one form of dementia, usually Alzheimer’s, and are not diagnosed with mixed dementia until an autopsy is performed.

More studies are needed to fully understand the symptoms most often present in mixed dementia. However, similar to vascular dementia and Alzheimer’s, the symptoms that develop are based on the location and severity of brain damage. Dizziness can potentially develop at any stage, depending on these factors. Mixed dementia highlights the importance of thorough evaluation for other forms of dementia when someone is diagnosed with Alzheimer’s disease.

Frontotemporal Dementia

Frontotemporal dementia (FTD) refers to a group of conditions called frontotemporal disorders that primarily affect the frontal and temporal lobes of the brain’s cortex. The most common form, behavioral variant FTD (bvFTD), causes changes in thought processing. Although bvFTD can run in families, the cause of bvFTD is unknown in most cases. The most common symptoms are personality, judgment, and behavioral changes. People may become disinterested in family or activities that used to bring joy, have increased impulsivity, repeat themselves often, and have difficulty problem-solving. As with Alzheimer’s, people can also develop balance problems and dizziness as their disease progresses.

Additionally, bvFTD can occur together with movement disorders, such as amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. Although rare in combination, bvFTD-ALS and bvFTD with parkinsonism are characterized by balance issues from muscle weakness and stiffness, respectively.

Lewy Body Dementia

Lewy body dementia (LBD) is the third most common type of dementia. Although scientists understand that abnormal protein deposition is involved, the exact cause of LBD is unknown. LBD most commonly causes visual hallucinations (seeing things that are not actually there) and changes in concentration, attention, and wakefulness. These symptoms often change throughout the day, and this fluctuation helps differentiate LBD from Alzheimer’s. LBD also causes movement difficulties, including balance problems and dizziness, more often than Alzheimer’s. Movement-related symptoms can develop early on in the disease or as it progresses, but symptom development varies on an individual basis.

Treatment

As most types of dementia cannot be cured, treatment focuses on symptom management and preserving a person’s quality of life. Whenever someone with dementia has dizziness, they should be evaluated by a health professional. A thorough can help identify possible causes for dizziness other than dementia, including medication side effects and treatable medical problems, such as heart disease. Commonly used medications that can cause dizziness include certain antidepressants, anti-seizure medications, blood pressure-lowering medications, and sedatives. Immediate medical attention is recommended if a person experiences sudden, severe headaches, one-sided weakness, difficulty speaking, or chest pain in addition to dizziness.

Occupational and Physical Therapy

Occupational and physical therapists (OTs and PTs) can also be helpful with regard to managing dizziness and balance problems caused by dementia. Safety is a primary concern when people with dementia become dizzy, given that older people are most commonly affected and at an increased risk of falling. OTs and PTs can provide helpful recommendations for keeping the home as safe and useable as possible. They can also work with people to reduce muscle weakness and stiffness through safe exercise. Improved muscle strength and flexibility can help prevent falls when someone with dementia is dizzy.

There are also exercises that can be done at home with the help of a loved one to improve balance. The exercises described below are low-impact, meaning they slowly raise the heart rate and exert less pressure on the joints, and focus on leg muscle strengthening, as well as preserving bone density. Importantly, all at-home exercises should be discussed with a physical therapist before starting to ensure safety and proper form.

Single Leg Stand

1. Stand next to a chair, only touching the chair if needed
2. Lift a leg to stand on one foot and hold for 10 seconds
3. Return the foot to the floor and repeat 10 times, if possible, on each side

Calf Raises

1. Stand holding the back of the chair, with assistance if needed
2. Lift the heels as high as possible, onto tiptoes
3. Place the heels back on the floor and repeat 10 times, if possible

Straight Leg Raises

1. Lie down on your back, making sure that the lower back is in contact with the floor
2. Bend one knee to 90 degrees with the foot on the floor, keeping the other leg straight
3. Lift the straight leg to the same level as the bent knee and lower back down
4. Repeat 10 times, if possible, on each side

1-Leg Stand

1. Stand near a chair or countertop for balance assistance, if needed
2. Stand on one leg as long as possible, up to 30 seconds
3. Switch legs and try to repeat 3 to 5 times on each side
4. When this exercise gets easier, try doing additional activities while standing on one leg, such as brushing your teeth or while washing dishes

Sit to Stand and Stand to Sit

1. Stand up from a chair without using the arms for assistance
2. If difficult at first, sit on a firm pad that lifts you and makes standing easier
3. As you return to a seated position, slowly lower your body into the chair without dropping suddenly to a seated position
4. Repeat as many times as possible (doing this exercise while watching TV is recommended)

Mobility aids are also typically recommended for people with dementia who experience dizziness and balance problems. These include canes, walkers, and rollators (walkers with wheels). Importantly, these may not be advisable for everyone with dementia, as operating a mobility aid requires a certain level of brain function that may not be possible for all individuals. The option of using a cane or walker should be discussed with a health professional beforehand. Important considerations for cane use include:

• Usually, a better option if a person favors one side
• Holding a cane in the hand opposite the problematic side
• Height should be at about the hip level without causing shoulder raise
• Foam handles help with a weak grip
• Rubber tips improve cane traction
• An extra attachment is often needed on the cane end when traveling over icy areas
• A cane should be hung on a hanging hook, to prevent tripping

Considerations for walker and rollator use include:

• Having added support for half of the body provided by both arms
• The possibility of having a seat if a person needs rest
• Rollators are easier to turn, but also require the ability to apply brakes

Two other useful options for people with dementia and dizziness are personal alarms and fall sensors. Personal alarms are an option for people who can operate them. They are worn and activated by the person if a fall occurs. Fall sensors are an alternative option that does not require operation by the person wearing them. These sensors will automatically alert a person’s loved one when they experience a sudden motion that is consistent with a fall.

Summary

Depending on the type of dementia and the part of the brain affected, dizziness may occur in the early or later stages of dementia. Whenever someone is diagnosed with a form of dementia, the individual, along with loved ones, should be prepared for potential balance problems and dizziness.

Managing these and other symptoms of dementia requires a team of caretakers that includes loved ones, physicians, and therapists, among others. Physical therapists can be especially beneficial in helping patients enhance physical strength and improve balance. At FYZICAL, expert physical therapists are available to assess balance and identify people at risk of falling. They will create an individualized treatment program specific to a person’s needs, taking into account other symptoms of dementia that affect mobility.

Especially useful for people with dementia, FYZICAL has equipment such as the Safety Overhead Support (SOS) system, which uses a harness and ceiling-mounted rails to allow people to exercise without fear of falling. If you or a loved one has dementia and balance difficulties, call FYZICAL to learn more about safe physiotherapy options to improve symptoms and promote a better quality of life.