Expert: Mary Gordon - 3/11/2009

Question
Hi Mary,

My 78 year old mother has shown signs of dementia for the last 5 or 6 years and was formally diagnosed with Alzheimers type dementia last year.  She has alway led a very healthy lifestle, walking up to an hour everyday, etc. In the last year or two we have noticed that she is slowly leaning farther and farther to the left. If you mention that she is leaning she is able to stand up straight for a moment or so but immediately goes back to leaning. We are concerned that very soon this will cause her to lose her balance. She recently had an MRI and the tests results showed that she had experienced several mini strokes.  The doctor did not seem concerned and did not recommend any changes in her medical treatment.  My question is as follows:  Could the ministrokes have caused her body to gradually contort like this or could there be another cause? Also, should we be concerned about the ministrokes and take any steps to avoid her having more of them? Thank you.

Answer
Hi Patricia.

I'm not sure how your mother was originally diagnosed - did they put her through some comprehensive testing before they decided it was Alzheimer's type dementia, and not Lewy Body or multi-infarct ?  

Gait problems, and balance issues are common in many dementias. Irrespective of the cause, as brain damage advances, the problems get worse and worse until the person looses their ability to walk. Issues include impaired physical coordination (ataxia) which starts to show itself in a shuffling gait; slowness of movement; and an altered posture such as the leaning you observed.

When they are leaning significantly, it is sometimes called Pisa Syndrome - although you will see that described as rare, it really isn't. It happens to people with various kinds of brain lesions, Parkinson's disease (which causes a form of dementia itself), Lewy Body dementia, in Alzheimer's, and as a side effect from certain neuroleptic drugs or cholinesterase inhibitors (a class of drugs used to treat AD).  It is a stooped posture with pronounced leaning, generally forward or to one side.

It is very likely your mother has vascular dementia as well as whatever else is happening to her. It is also called multi-infarct dementia and it is caused by an endless series of tiny blockages or strokes. Each one can be so small the person shows no signs of what you would think of as a stroke symptom. Sometimes the person has some very mild symptom that passes quickly. The experts used to call these TIAs or transient ischemic attacks. Not long ago, those same experts thought they caused no damage, but now it appears that each one causes a small amount of damage, and over time it accumulates to cause brain damage to the point of dementia and other neurological impairment.

When a person has both vascular and another cause of dementia at the same time, it gets called a mixed dementia.

If as you say, she has had a healthy lifestyle, then she may already be doing everything possible to reduce her vascular risk - exercising, eating well, not smoking, keeping her cholesterol and blood pressure down, managing diabetes well if she has it.

Beyond that, really, there isn't much you can do. Sadly, for any of these progressive causes of dementia, medical science still has very little to offer in terms of answers or treatments.

Hope this helps. I know it isn't what you wish were true, since you love your mother. She's lucky to have you asking questions and looking out for her health.

Mary G.