“We thought Mom only had dementia, until I took her to a neurologist, and we found out she has more Parkinson’s than dementia. Her balance is off, and her left side is weak. Her hands tremble from time to time, and she walks really slow and humped over,” shared a myALZteam member.

Shuffling feet, hunched shoulders, stiff limbs, and wobbly balance — are these normal signs of aging, or are they more frequent in people with dementia? For some people, a stooped position points to problems in the bones, muscles, and joints. But for people with dementia, changes in posture, sometimes called “dementia posturing,” may be caused by brain damage.

Talking to your loved one’s doctor can help you figure out what’s causing their poor posture and how to manage it to prevent falls and other injuries. This article explains what to expect if dementia is causing posture changes.

How We Maintain Posture and Balance

Posture refers to the way we position our bodies, and it’s closely linked to balance. Thierry Paillard, a French neurophysiologist, defined posture as “a permanent reestablishment of balance.” In other words, posture isn’t possible without balance, and our bodies are constantly rebalancing themselves to maintain a certain position.

Posture and balance are controlled by a part of the brain called the cerebellum, along with help from other systems like your inner ear and muscles. The cerebellum is at the back of the head near the neck. It also helps you move your muscles when you want to. Other parts of the brain, like the frontal lobe and brainstem, also send signals that tell your body how to move.

Body Positioning and Balance

The brain balances the body in response to what we sense around us, including what we can see. However, we can sense how our body is positioned even when we can’t see it. This is called proprioception, and it’s the reason we can climb stairs without looking at our feet. Proprioception is important for keeping you balanced.

The five tiny organs in your inner ear help sense movement and position, while sensors in your skin, muscles, and joints send more clues to your brain to help you stay steady.

These receptors constantly send signals to the brain, and the cerebellum, frontal lobe, and brainstem react to the information by signaling for specific muscle movements. This is how we stay balanced — and your body does it all almost instantly.

How Dementia and Brain Changes Lead to Posture Changes

Dementia is a condition that leads to brain damage and atrophy, which means the brain slowly shrinks. Neurons, which relay messages to and from the brain, stop working, die off, and usually do not grow back. The brain shrinks where the neurons used to be.

Dementia symptoms vary depending on which parts of the brain are damaged. Posture and balance depend on different parts of the body working together. If certain areas of the brain are affected, these skills can be harder to control. In many cases, the brain changes that cause dementia affect multiple areas. If the brain damage is severe or affects important areas, problems with posture and balance may be easier to notice. Some types of dementia are more likely to affect certain parts of the brain, like the brainstem, which can help explain why certain symptoms show up.

Brainstem damage causes symptoms like:

• Poor balance
• Dizziness
• Poor coordination
• Muscle weakness
• Difficulty walking
• Irregular heartbeat
• Breathing problems
• Changes in hearing and vision

Damage to the frontal cortex — the part of the brain that helps control movement, planning, and decision-making — can also affect the muscles and increase the risk of falls.

What Dementia Posturing Looks Like

Dementia-related changes in muscle strength, balance, proprioception, and posture are sometimes collectively referred to as “dementia posturing.” Someone with dementia may sway back and forth, hunch their shoulders forward, and shuffle their feet when walking. Some kinds of dementia can also cause movement problems commonly associated with Parkinson’s disease, such as slow, stiff movements and tremors.

Members of myALZteam have described some of the postural changes they’ve noticed in their loved ones:

• “My husband almost always lets his head hang down. I often remind him to have his shoulders back and chin up, which he does. Two minutes later, his head slumps down again.”
• “My husband’s spine is bowing out. He is in so much pain that it is hard for him to walk.”
• “I find that she shuffles more. I can literally hear her feet drag across the carpet or the flooring.”
• “Balance problems while going downhill were probably one of my first symptoms.”

Posture Changes Differ by Type of Dementia

The type of dementia someone has may also affect their posture. For example, a 2024 study looked at postural sway (small movements the body makes to stay balanced) in people with no thinking or memory problems, Alzheimer’s disease, dementia with Lewy bodies, and vascular dementia. The study found that the further someone leaned away from their center of gravity, the worse their postural sway. People with vascular dementia showed the worst postural sway, followed by those with Lewy Body dementia and Alzheimer’s disease.

The same study also found that people with Lewy body dementia were more likely to stand in a stooped position — with rounded, drooping shoulders, a forward-leaning head, and tucked hips. They’re also more likely to lean sideways.

In addition, study participants with Alzheimer’s disease had a harder time keeping their posture and balance when their eyes were closed compared to those with other types of dementia.

Physical and Occupational Therapy May Slow Progression of Posture Changes With Dementia

Although there’s no cure for dementia, physical therapy and occupational therapy may slow its progress, improve quality of life, and reduce the risk of falling due to poor balance. Falls can lead to fractures, head trauma, or hospitalization. Studies show that older adults with dementia are more likely to fall than those without dementia. Here are some ways physical and occupational therapy can help:

• A physical therapist can guide your loved one through a series of exercises for balance, grip strength, and flexibility, which may help slow down some of the postural changes associated with dementia.
• An occupational therapist can help you find alternative ways to care for and communicate with your loved one based on their symptoms. They often work on everyday movements and body positioning to help people stand, walk, or reach while keeping good posture and balance.
• Making changes at home can also help prevent falls. This might include adding handrails in the bathroom, keeping pathways well lit, and removing things that could cause someone to trip, like loose rugs and clutter.

If you’re concerned about changes in your loved one’s balance and posture, talk to a healthcare provider to get support. They may refer you to a specialist who can conduct various screening tests and develop a plan for slowing down these symptoms as dementia progresses. You don’t have to navigate this alone — help is available to support both you and your loved one.

Talk With Others Who Understand

On myALZteam, the social network for people with Alzheimer’s and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s.

What postural changes have you noticed in your loved one with dementia? What strategies have you used to prevent falls? Share your experience in the comments below, or start a conversation by posting on your Activities page.