Repeated falls are common for people LBDs, either dementia with Lewy bodies or Parkinson’s dementia. Falling can be a very early symptom of dementia with Lewy bodies (DLB) and may occur with or without trigger. It can be related to parkinsonism (e.g. slow movement, rigidity and problems walking), cognitive fluctuations, or to ‘blood rushes’ or ‘dizzy spells’ (orthostatic hypotension) seen in 3-5 out of 10 people with DLB;
Around half of all people with DLB will experience ‘freezing’ while they are moving, They stop suddenly for no external reason and can feel as though their feet are stuck to the floor or that they can’t move easily, which can make them feel unsteady and puts them at risk of falling. ‘Freezing’ can last for a few seconds or minutes.
Parkinson’s UK’s fact sheet on Falls goes into more details about the link between parkinsonism and falls and provides useful suggestions for avoiding falls.
People who have an LBD can struggle with movements that they have been doing all their life because changes in part of the brain called the Basal Ganglia affect their ability to prepare for, start, time and organise the sequence of movements. They may have difficulty in doing two or more habitual tasks simultaneously or in ‘set shifting’ (changing their movement or thinking in response to changes in the environment). It is also common for people with a Lewy body dementia (LBD) to need more time for mental processing.
Turning around can be a particular problem. People without a movement problem can normally turn around to face behind them (turning 180 degrees) in two or three steps. But people with parkinsonism may need to take four, five or more steps. When looking at spaces in your home and in moving around, create/look for enough space for the person with an LBD and another person to move beside them, if they need help. Aim for a gradual rather than sharp change of direction, as people with an LBD can have trouble adjusting to shifting their weight.
Falls are also more likely when the person with an LBD is reaching above their head or below their knees or rising from sitting down.
For more help, talk to a physiotherapist about how to enable the person with an LBD to keep the best posture they can, be as stable as possible and about how to provide ‘cues’ (prompts) to help them move around. To help the physiotherapist understand why the falls are happening and work with you to prevent them occuring, it can be useful if you keep a note of:
- WHEN the person with an LBD fell
- WHERE they were when they fell
- WHAT they were doing at the time
- WHAT they/you think caused the fall
- HOW they landed (direction)
- HOW they got up again
[Thanks to Fiona Lindop, Specialist Physiotherapist at London Road Community Hospital, Derby for her help with this article and to Parkinson’s UK for information from their Falls fact sheet]