Paratonia in Dementia: A Systematic Review

Abstract

Background: Paratonia is a dementia-induced motor abnormality. Although paratonia affects virtually all people with dementia, it is not well known among clinicians and researchers. Objective: The aim of this study was to perform a systematic review of the literature on the definition, pathogenesis, diagnosis, and intervention of paratonia as well as to propose a research agenda for paratonia. Methods: In this systematic review, the Embase, PubMed, CINAHL, and Cochrane CENTRAL databases were searched for articles published prior to December 2019. Two independent reviewers performed data extraction and assessed the risk of bias of the studies. The following data were extracted: first author, year of publication, study design, study population, diagnosis, assessment, pathogenesis, therapy and interventions. Results: Thirty-five studies met the inclusion criteria and were included. Most studies included in the review mention clinical criteria for paratonia. Additionally, pathogenesis, method of assessment, diagnosis, and paratonia severity as are interventions to address paratonia are also discussed. Conclusion: This systematic review outlines what is currently known about paratonia, as well as discusses the preliminary research on the underlying mechanisms of paratonia. Although paratonia has obvious devastating impacts on health and quality of life, the amount of research to date has been limited. In the last decade, there appears to have been increased research on paratonia, which hopefully will increase the momentum to further advance the field.

Electromyographic Patterns of Paratonia in Normal Subjects and in Patients with Mild Cognitive Impairment or Alzheimer’s Disease

“…In participants with cognitive impairment, we found that prevalence and severity of paratonia (both facilitatory and oppositional) were greater than in seniors, in line with the literature [17]. In comparison to seniors, facilitatory paratonia was more pronounced in MCI and oppositional paratonia in AD, confirming that facilitatory paratonia prevails in the initial stages of cognitive impairment while oppositional paratonia is detected more frequently in overt dementia [10].…”

“…Facilitatory paratonia has also been linked to frontal lobe dysfunction in more recent times [4]. Paratonia in seniors and patients with cognitive impairment is usually attributed to reduced inhibitory efficiency of frontal areas due to physiological ageing or pathological degeneration [17], respectively.…”

“…An expert consensus [7] and the paratonia assessment instrument (PAI) [10] provide some clues to guide the diagnosis based on the observations made in clinical practice. Unlike rigidity, oppositional paratonia is velocitydependent; unlike spasticity, it is evenly distributed in flexor and extensor muscles, and shows no clasp-knife phenomenon [7,17].…”

A Biopsychosocial Model of Mealtime Management in Persons with Dementia, an Asset-Based Approach to Patient-Centered Care

“…Due to changes in motor control, PWD face reduced ability to participate in activities of daily living (ADLs), such as feeding and other mealtime related tasks, which may be a result of reduced fine motor control commonly seen as the disease progresses [ 28 ]. Changes in gross motor control may be a result of paratonic rigidity seen in dementia which can place the patient at increased risk of postural difficulties and reduced oropharyngeal swallow control [ 29 , 30 ]. Combined with other biological and psychosocial features related to cognitive decline, malnutrition is a significant risk for PWD [ 9 , 12 ].…”

Physiotherapists are pivotal in the care of people living with dementia

“…These interventions may include supportive materials, the concept of Passivity in Daily Life (PDL) in which the current status of disability is accepted, botulinum toxin injections, rocking movements (harmonic techniques), massage, warm water baths, heat applications, snoezelen (also called controlled multisensory environment (MSE)), and other relaxation techniques. When an intervention is applied, it should be tailored to meet specific goals and effectiveness methodically monitored using valid and reliable measures [14]. However, most of these interventions have limited evidence supporting their use in paratonia, so this is a critical area for more research [14].…”