Paratonia in Advanced Dementia: A Frequently Misunderstood Movement Disorder.
J Am Med Dir Assoc 2026 Jun 08; :106284. [Online ahead of print]

Abstract

Paratonia is a movement disorder characterized by involuntary muscle stiffening that affects nearly all individuals with advanced dementia, yet it remains poorly recognized in routine clinical practice. Often misinterpreted as intentional resistance to care, untreated paratonia may progress to muscle contractures with secondary consequences, including pressure injuries, pain, and difficulty with caregiving. This clinical review provides clinicians with practical guidance in recognizing paratonia as a reflexive phenomenon rather than a behavioral disturbance. Three illustrative cases demonstrate presentations across care settings and clinical presentations. The article addresses bedside assessment, medications to avoid, indications for specialist referral, and both pharmacologic and nonpharmacologic management options.

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Authors+Show Affiliations

Perri GADivision of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Austin Centre for Neurology and Behavioral Supports, Baycrest Health Sciences, Toronto, Ontario, Canada.
Hobbelen HResearch Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; FAITH Research, Groningen, Leeuwarden, The Netherlands; Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Cuppage JDivision of Care of the Elderly, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Naglie GDepartment of Medicine, Baycrest Health Sciences, Toronto, Ontario, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Feldman SDivision of Care of the Elderly, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Khan ODivision of Physiatry, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, St Catharines, Ontario, Canada.
Ismail FWest Park Healthcare Centre, Toronto, Ontario, Canada; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Boulias CWest Park Healthcare Centre, Toronto, Ontario, Canada; Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Kleiner GAustin Centre for Neurology and Behavioral Supports, Baycrest Health Sciences, Toronto, Ontario, Canada; Katz Interprofessional Research Program in Geriatric Dementia Care, Rotman Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: Gkleiner@baycrest.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

42257638