When you think about dementia, memory problems probably come to mind first. However, dementia can also affect your loved one’s balance, walking, and coordination. These physical changes sometimes receive less attention, but they can seriously impact someone’s everyday life.
Dementia affects balance and mobility because changes in the brain can interfere with movement and spatial awareness. As the disease progresses, your loved one may find it increasingly difficult to walk or complete other physical activities.
Of course, balance problems aren’t always caused by dementia. Understanding the possible relationship can help you recognize changes and support your loved one as their needs evolve.
Studies on Dementia and Balance
Researchers have long been interested in the relationship between cognitive decline and physical movement.
In 2016, researchers from the University of California, Irvine examined whether poor physical performance was associated with a higher risk of dementia among adults aged 90 and older. The study, published in the Journal of the American Geriatrics Society, identified an association between poorer performance on walking and standing balance tests and subsequent dementia risk.
More recent research has strengthened our understanding of this relationship. A 2024 systematic review and meta-analysis, published in Ageing Research Reviews, examined a condition known as motoric cognitive risk syndrome. This describes older adults who experience both slow walking speed and subjective cognitive concerns, despite not having dementia or a mobility disability.
The researchers found that this combination was associated with an increased risk of future cognitive impairment and dementia.
These findings are interesting because walking involves much more than muscle strength. Your brain has to coordinate movement, process information from your surroundings, and make constant adjustments to keep you upright. We do most of this without even thinking about it.
When cognitive abilities begin to decline, these processes can become more difficult.
However, the research doesn’t mean that slow walking or poor balance can independently diagnose dementia. Many other conditions can affect mobility, so it’s important to consider these changes alongside other symptoms.
For further information, see our guide to how dementia affects the brain and behaviors.
5 Mobility and Problems to Look Out For
So, what physical changes should you look for? Here are five mobility and balance problems that may occur in people living with dementia.
1. An Unsteady Gait
A person’s gait describes the way they walk, including the length of their stride and how they coordinate their movements.
You may notice your loved one walking more slowly, shuffling their feet, or becoming unsteady. Perhaps they’ve started holding onto furniture for support or you notice they seem to bump into things.
Dementia can contribute to these difficulties, although the relationship varies depending on the type of dementia and the areas of the brain affected.
Some movement difficulties are associated with parkinsonism, a group of symptoms that can include slowed movement, muscle rigidity, and tremor. However, slower walking alone doesn’t establish that someone has parkinsonism.
If you notice a persistent change in the way your loved one walks, don’t jump to a conclusion. Instead, speak to their doctor. Identifying the cause can help you determine what support they need.
2. Slowness of Movement
Alongside changes in gait, some people with dementia experience a general slowing of movement.
Your loved one may develop a stooped posture, take shorter steps, or struggle to turn around. Instead of pivoting naturally,you’ll often see somebody take several small, shuffling steps to change direction.
You may also notice that ordinary activities, such as getting out of a chair or walking from one room to another, take considerably longer than they once did.
Slowness and stiffness are particularly associated with Lewy body dementia. The National Institute on Aging explains that movement symptoms may appear early in some people with this condition, although others don’t develop noticeable mobility difficulties until later.
You can help by allowing your loved one more time to move and making changes around the house that reduce physical obstacles. Depending on their needs, a walking aid may also provide extra help. A physical therapist can assess whether a cane or walker would help and show your loved one how to use it safely.
3. Increased Fall Risk
Dementia can increase the risk of falls by affecting coordination, balance, visual perception, and the ability to notice hazards.
Your loved one may have difficulty judging distances or stepping over obstacles. Even familiar surroundings can become difficult to navigate.
Falls are particularly concerning for older adults because they can lead to fractures and hospitalization. A secondary effect is the subsequent loss of independence.
Fortunately, there are steps you can take to reduce these risks.
The Centers for Disease Control and Prevention recommends appropriate strength and balance exercises, medication reviews, and individual fall-risk assessments for older adults.
Encourage your loved one to remain physically active at a level appropriate for their abilities. We’re not walking about going to the gym or doing heavy-duty exercises. Walking, stretching, or supervised balance exercises can help maintain strength and coordination.
You can also look for everyday opportunities to keep them moving. A short walk together or a familiar physical activity will likely be more appealing than a formal exercise routine.
The important thing is to choose activities they can enjoy safely. If your loved one already struggles with balance, consult their healthcare provider before introducing new exercises.
For more practical suggestions, visit our caregiver resource on exercising for brain and body health.
4. Difficulty in Starting to Move
Another mobility problem you may see is difficulty initiating movement. Perhaps your loved one hesitates before taking their first step or struggles to get out of a chair.
In some neurological conditions, people experience what doctors call freezing of gait. They may feel temporarily unable to move their feet forward, even though they want to walk.
These symptoms can occur with parkinsonism, including in some people with Lewy body dementia. Other conditions can also interfere with movement initiation.
If this happens, resist the temptation to hurry your loved one along or physically pull them forward. Give them time and make sure they have somewhere stable to hold onto if needed.
A healthcare professional or physical therapist can help identify the cause and recommend techniques that make movement easier and safer.
5. Stiffness
Muscle stiffness or rigidity is another movement symptom associated with parkinsonism.
You might notice that your loved one struggles to move their arms or legs comfortably. They may find it difficult to turn around, change positions, or walk with their usual movements.
Of course, stiffness is common among older adults for many reasons. Arthritis, joint pain, and other physical conditions can produce similar complaints.
It’s important not to assume that these difficulties are necessarily related to dementia, particularly when they appear alongside other physical symptoms.
Speak to your loved one’s healthcare provider about any persistent stiffness or discomfort. They can help determine the cause and whether treatment, physical therapy, or adjustments to daily activities might help.
At What Stage of Dementia Do Balance Problems Begin?
There isn’t one particular stage when people with dementia begin experiencing mobility problems.
In Alzheimer’s disease, significant difficulties with walking and independent movement generally become more common as the condition progresses, although subtler changes can appear earlier.
Other forms of dementia may affect mobility sooner. Lewy body dementia, for example, can cause walking difficulties, stiffness, and balance problems relatively early in the disease.
If you’re trying to understand what your loved one’s physical changes mean, consider them alongside their other symptoms. Balance problems alone can’t tell you how far dementia has progressed.
Our guide to the stages of dementia and Alzheimer’s disease explains how symptoms and care needs can change over time.
What Can You Do?
If you’ve noticed changes in your loved one’s walking or balance, there are several ways you can help.
Start by finding out whether these difficulties are related to dementia, another medical condition, or a combination of factors. From there, you can make changes that support their safety and independence.
Pay Attention to Your Loved One’s Gait
Watch how your loved one walks and moves throughout the day. Are they taking shorter steps? Have they started shuffling their feet or holding onto furniture?
Think about when these changes began and whether they’re becoming more noticeable. Perhaps your loved one now struggles to get out of a chair or has begun avoiding stairs.
Keep track of any falls or near misses, too. These observations can help their doctor understand what’s happening.
If their mobility changes gradually, arrange an assessment rather than assuming these difficulties are an unavoidable part of aging or dementia.
Sudden changes are different, though. An abrupt loss of balance or difficulty walking can be a warning sign of a stroke, particularly when accompanied by weakness, vision changes, or difficulty speaking. Call 911 immediately if these symptoms appear suddenly.
Talk to Their Doctors
If your loved one is being evaluated for possible dementia, make sure their healthcare provider knows about any changes in balance or mobility. As mentioned earlier, we often think of memory or cognitive issues as the worrying signs, but a healthcare professional would want to know if there are physical issues, too.
Yet, even if they already have a dementia diagnosis, don’t automatically attribute new physical symptoms to the disease.
For example, some medications can cause dizziness, drowsiness, or changes in blood pressure that make falling more likely. Inner ear problems, poor vision, and other medical conditions may also contribute to your loved one’s challenges.
Ask their doctor whether a medication review or further assessment would be helpful.
Make Your Loved One’s Home More Accessible
Take a look around your loved one’s home. Are there obstacles that might make walking difficult? Does the lighting allow them to see steps, furniture, and changes in floor level clearly?
You may be surprised how much difference a few practical changes can make.
Consider the following:
- Remove or reduce things to trip on. Remove loose rugs and clutter, keep walkways clear, and make sure rooms and hallways are well-lit.
- Consider walking aids. If your loved one needs support, ask a physical therapist whether a cane or walker would help. Make sure they know how to use it safely.
- Explore physical therapy. A physical therapist can recommend exercises suited to your loved one’s abilities, helping them maintain strength and balance in core, target areas.
- Watch for changing needs. Pay attention if your loved one starts struggling with stairs, standing up, or moving between rooms. They may need a different level of assistance.
Try to involve your loved one in these decisions wherever possible. If possible, we want to avoid situations where you are stepping in and imposing these changes.
Supporting Mobility as Dementia Progresses
As dementia progresses, you might find that helping your loved one remain active and independent becomes more challenging.
There may also come a time when your loved one needs more support than you can comfortably provide at home.
At Bridges® by EPOCH, our memory care communities offer thoughtfully designed living spaces, secure outdoor areas, and personalized care that supports residents’ changing abilities. Our teams encourage appropriate physical activity while helping residents with everyday tasks.
If you’re beginning to explore additional care options, The Bridges Guide to Memory Care explains what specialized memory care involves and what to consider when evaluating a community.
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