The 2010 Johns Hopkins Memory White Paper

Excerpt from page 35, by Susan Weiner

Maintaining Balance in Dementia
How to build strength and prevent falls

Cognitive impairment affects more than memory and thinking. It can interfere with a person’s motor and balance control, resulting in difficulties walking, slowness of  movement, a shuffling gait, and general unsteadiness. Balance problems are often an initial sign of dementia due to Parkinson’s disease, dementia with Lewy bodies, stroke,  or normal-pressure hydrocephalus (an abnormal increase of cerebrospinal fluid). Losing balance and falling down is common among those cognitively impaired and often occurs during routine activities such as getting out of bed, standing up, climbing stairs, and using the bathroom. Loved ones may break bones or suffer other serious injuries  that threaten their health and longevity. Nearly two million adults older than age 65 were treated in hospital emergency rooms for injuries related to accidental falls in 2007, according to the Centers for Disease Control and Prevention. Individuals with cognitive decline have a three times higher risk of injuries from falls than cognitively unimpaired  elders.

Exercise Can Help
Inactivity and lack of exercise often accompany Alzheimer’s disease and other dementias and further weaken muscles and decrease flexibility, affecting the way individuals
walk and increasing the likelihood of falling. An exercise plan can counteract this increased risk by improving balance and mobility. It can also help your loved one maintain independence, promote a normal routine, and enhance mood. Ongoing strength and balance training may even eliminate or forestall the need for walking assistance, negating some safety issues. Whether exercise and balance routines are incorporated at home or professionally, it’s never too late to enhance coordination. Researchers have found  that elderly people with dementia in nursing homes who participated in an exercise program were able to improve balance after just six months. Caregivers may be able to aid in the process. Research from 2008 showed that when caregivers motivated and taught participants with dementia a tailored set of exercises, they fell significantly less than  those in the group that did not exercise. After 12 months, the exercise group improved their balance, while steadiness deteriorated in those who didn’t exercise.

Getting Started
A health professional should be consulted before beginning any exercise program, and types of physical activity should be individualizedto the person’s abilities.  For those with limited mobility, repetitive everyday routines like folding laundry or washing dishes can be used to improve coordination and increase activity. Routines can also decrease anxiety, because they don’t require as much thought and concentration.    People in the early stages of cognitive decline may find walking, dancing, stationary bicycling, yoga, and tai chi to be helpful in building balance, stamina, and strength. Swimming and water aerobics also are good options and require less balance and are easier on your joints. Most important, choose an activity that the person is likely to enjoy and stick with. Doing activities with someone else offers added incentive and pleasure to continue with  any activity program.

• Start out with 10-minute exercise sessions and work your way up.
• Avoid slippery floors and throw rugs.
  
• Make sure the area is well lit and uncluttered.
  
• If maintaining balance is difficult, exercise within reach of a rail or grab bar.
  
• If standing is a challenge, exercise on a bed or secure floor mat.
  
• If the person begins to feel hurt or sick, make sure to stop the activity immediately.
  
• A physical therapist can also design a special balance exercise plan depending on skill level. See the box above for an example of an exercise for beginners. Your doctor can  provide a referral to a therapist or may even have diagrams of exercises to try at home, if it is safe to do so.