The physical symptoms off dementia

What is dementia?

Dementia refers to a number of different medical conditions causing impaired cognitive function and other symptoms due to a disruption to neurons and their connections in the brain. When these are impaired, messages cannot be easily sent around the brain, and this can negatively impact things like speech, understanding, and movement. As the disease progresses, a person with dementia will begin to notice daily activities are affected, and eventually they will require constant care. There are several different types of dementia, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and more. Any type may cause cognitive symptoms such as issues with memory, thinking skills, judgement, reasoning skills, communication, mood, behaviour, balance, motor skills, and more. You may find more information about dementia in our introductory guide to what dementia is.

What are some common physical symptoms of dementia?

Physical symptoms of dementia tend to show themselves more in the middle and late stages of the disease, but it is not impossible for someone with dementia to experience mild physical symptoms from the early stages. 

Physical symptoms of early stage dementia 

In the early stages, mild cognitive symptoms may start to show, while physical symptoms may be unnoticeable or not present at all. Often, physical symptoms are mistaken for the age-related health conditions an older adult might naturally develop over time. Whether you suspect dementia or you have an early diagnosis, staying as active as possible in this early stage is incredibly important. According to the Alzheimer’s Society, those living with a long-term health condition are twice as likely to become inactive, but evidence suggests being active can help in managing many health conditions, and could reduce symptom impact and severity.In those with dementia, physical activity (if they are able) could promote improved cognition, independent functioning, and psychological health, according to studies.

Physical symptoms of middle stage dementia

As dementia progresses and more areas of the brain are impacted by the condition, both cognitive and physical symptoms will usually start to worsen, making them more noticeable. At this stage, carrying out daily activities can become more challenging, such as getting washed and dressed each day, cooking food, or keeping the house clean. In the middle stages, depending on the type of dementia, repetitive movements or muscle twitches could be present. Certain types of dementia are known to cause tremors, such as Lewy body dementia, which is associated with the tremors seen in Parkinson’s disease. Sleep issues can also arise due to a lack of melatonin production – the sleep hormone. Caregivers report sleep problems as one of the most distressing dementia symptoms seen in their roles, causing changes to the person’s sleeping patterns, daytime napping, trouble getting to sleep, insomnia at night or constant waking, reduced deep sleep, or sundowning symptoms. Sleep issues could also be caused by medication to treat dementia, a lack of sufficient physical exercise throughout the day, or confusion about when it is night time. Older adults are more prone to sleep disturbances in general, but studies find an estimated 60-70% of those with cognitive impairment or dementia experience sleep disturbances. If sleep is a particular problem for you or a loved one with dementia, you may want to try maintaining a regular sleep schedule, limiting daytime naps, getting more physical exercise if able, getting more light exposure during the day, avoiding stimulants like caffeine, treating pain, and optimising the bedroom environment for sleep. If you are experiencing these middle stage symptoms, or other symptoms, it is always important to relay this information to your doctor so they can provide treatment options or advice. They may be able to offer tips for getting more sleep, medication to reduce tremors, or something else.

Physical symptoms of late stage dementia 

In the late stages of dementia, physical symptoms – as well as cognitive and behavioural symptoms – can become increasingly prominent, with some people requiring full-time care when they lose the ability to carry out necessary daily personal care tasks. Some of the physical symptoms a person with advanced dementia may face include: 

Mobility issues

Studies find those with late stage dementia may suffer from issues with balance, gait, coordination and posture, which can lead to problems moving safely around the home, and falls. Mobility issues can be caused by dementia itself, or could be the result of dementia medications, co-occurring conditions like sight loss, or an environment that is not optimised for someone with dementia.Mobility problems may lead to the person needing help to walk on their own, and they may eventually require a wheelchair or other aid to move around. Although mobility can be an issue for older people in general, studies suggest those with a cognitive impairment tend to report higher levels of disability than those without a cognitive condition. Disability can occur at any point in the dementia progression, but is thought to mostly occur in the late stages. If someone has mobility issues, there are a number of other things caregivers must be aware of, such as checking for pressure ulcers and risk of blood clots. As well as mobility, dexterity could become a problem for those with advanced dementia, as certain muscles in the body begin to deteriorate. This can also lead to difficulty swallowing, which affects how a person eats, and their nutritional intake. If your loved one has difficulty swallowing food and liquids, it is important to address this with their doctor and take steps to prevent choking or other serious problems. You can read more about this in our guide to difficulty swallowing and coughing while eating in older adults.

Pain

While dementia itself is not thought to cause pain, a person with dementia could be experiencing pain but lacks the awareness or communication skills to tell someone or address it themselves. This could be due to another issue such as an infection, constipation, or a health condition like arthritis. Without the ability to identify and explain their pain, they could be living with long-term discomfort. Experts estimate around 50% of those living with dementia experience daily pain, and research also suggests that in those with chronic pain, cognitive decline is likely to progress more quickly. People with dementia are at risk of their pain being missed, identified too late, or assessed wrongly, which can lead to further issues and discomfort. This is a key reason why identifying and addressing pain in dementia patients is so crucial. If you are unsure whether a person with dementia that you care for is experiencing pain, try asking them questions about specific areas and types of pain until you get a positive confirmation from them, such as “Is your leg aching today?”, or “Do you have a sharp pain here?” Also keep an eye out for them groaning, grimacing, rubbing a specific body part, seeming physically uncomfortable, seeming worried during personal care tasks, or any other signs they may be in pain. 

Communication issues

For people with dementia, communicating effectively can start to become more and more difficult. They may lose the ability to find the correct language to illustrate their point, use the wrong words to describe things, or be unable to form words and sentences altogether. Dementia can impact the parts of the brain responsible for things like language and understanding, particularly in advanced dementia, so conversations with dementia patients at this late stage may need to be more creative in order to convey information and understand their needs. Behaviours, sounds, facial expressions and gestures may all become more important than language when communicating, so if you are looking after a loved one with late stage dementia, it is important to address communication concerns with their doctor early. They may be able to refer them to a speech and language therapist for more tools and advice. Communicating with dementia patients is important in order to address their needs, manage any pain, and ensure they are always comfortable.

Incontinence

In the late stages of dementia, incontinence could become an issue, and this can be bladder incontinence or bowel incontinence. This usually happens when dementia impacts the brain to the point where it is no longer able to send the appropriate signals to trigger a trip to the bathroom. Some other possible reasons for incontinence in dementia patients include things like not having the physical ability to react quickly enough to the sensation of needing to go to the bathroom, having a urinary tract infection (UTI) that causes a sudden urge to go, constipation or irritable bowel syndrome (IBS) that can make it harder to control bowel movements, prostate gland problems in men with dementia, medication side effects, or something else. 

Appetite and weight loss

Poor appetite can become an issue for those with late-stage dementia, and as a result, weight loss may occur due to insufficient nutritional intake. Some of the reasons for this could include eating difficulties (such as trouble chewing and swallowing), gastrointestinal issues (such as constipation), mouth pain (such as from dentures), or medication side effects. They may also experience depression symptoms, fatigue when eating, trouble communicating hunger or a dislike of the food, trouble with dexterity or coordination when eating, or they may not be getting enough physical activity to work up an appetite. Once you identify what the reason is, you can address it accordingly. For example, if dexterity issues are the problem, you may need to assist them when eating. Or, if they have mouth pain, you should help them visit a dentist to see what can be done about this. You may find some more helpful tips on this topic in our guide to handling appetite loss in older adults.

What are some other common physical complications of dementia?

When the above physical symptoms arise, it is important to think ahead to the possible complications that can occur as a result. Also, knowing the complications associated with a dementia diagnosis will allow you to carefully monitor your loved one’s health and ensure they are not in any unnecessary pain or discomfort. Some complications dementia patients may experience include: 

• A higher chance of contracting a urinary tract infection (UTI) than other older people, as studies suggest – you should watch for UTI symptoms, such as the person needing to urinate more often or during the night, a sudden urge to urinate, blood in urine, a high temperature or a very low temperature
• Poor nutrition when appetite is affected
• An increased risk of choking if they have difficulty swallowing
• Dental issues due to not being able to (or not remembering to) brush their teeth
• Personal safety issues, such as forgetting to turn the oven off
• A higher risk of pneumonia, as one 2023 study found

How should physical symptoms of dementia be managed? 

Managing the physical symptoms of dementia is possible for family caregivers, and requires regular medical check-ups in order to monitor and address any issues, such as mobility concerns, nutritional intake, and pain management.Encouraging regular exercise is important to maintain muscle strength and flexibility, and interventions such as occupational therapy could help them to maintain as much independence with daily living activities as possible in the early stages of dementia, and possibly in the middle stages depending on how advanced their symptoms are. Some things to consider when looking after a loved one with dementia include:

• Making sure they get adequate and balanced nutrition
• Setting them up with meals and snacks that are easy to eat
• Encouraging them to drink enough throughout the day
• Asking questions about any pain they are experiencing
• Ensuring the home environment is optimised and safe to prevent falls 
• Providing emotional support to alleviate anxiety and improve overall quality of life
• Being proactive with healthcare by scheduling regular doctor’s visits to check in
• Checking their teeth for signs of dental issues, denture problems, and more 
• Monitoring eyesight and hearing to see if these impact their communication skills 
• Checking for skin issues like pressure ulcers or irritation if they are bedbound 
• Look after their general physical health with things like nail care, foot care and more 
• Promote their general wellness by making sure they continue with enjoyable activities

How can home care be used for physical dementia symptoms?

The physical symptoms of dementia can be managed with the help of home care, whether or not you are already caring for someone with dementia at home. Specialist dementia care can assist with everything from everyday personal care activities, to providing mental stimulation, to helping with mobility issues, and much more. Although it is possible for families to manage a loved one’s dementia diagnosis alone, a dementia home carer can help by providing respite care for the family, addressing any health concerns that a family member without care training might miss, and being there for the dementia patient and their family throughout the process in order to anticipate their needs as the condition progresses. If you are looking into specialist care for dementia, you may want to ask a home care provider questions such as:

• How does a dementia carer help with the physical symptoms of dementia? 
• Is live-in care required in the late stages of dementia?
• What will a carer do to encourage physical activity? 
• How does care adapt over time to fit with the person’s changing physical needs? 

At Home Instead, we offer specialist, person-centred care that addresses both the cognitive symptoms of dementia as well as the physical symptoms that may arise. Our Care Professionals are trained to provide a high standard of dementia-focused care through our unique training programme created by ageing experts, dementia specialists and key medical practitioners from around the world. This training is assured by City & Guilds, so you can always feel confident that your loved one is in safe hands when you are not around. You may find more helpful information in our guide on how to choose and arrange home care.We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.