When Maria's mother stopped resisting her morning shower, her daughter thought it was acceptance. But neurologist Dr. Galit Kleiner at Baycrest in Toronto has spent years untangling a more complex truth: what looks like defiance in advanced dementia is often involuntary muscle resistance, a condition called paratonia—and the distinction matters profoundly for how we care.
For decades, caregivers and clinicians have encountered people living with advanced dementia who stiffen, resist movement, or become rigid during daily care like bathing, dressing, or feeding. That stiffness was frequently misread as behavioral resistance, even stubbornness. The assumption shaped care strategies, sometimes leading to frustration on both sides of the interaction. But landmark research Kleiner and her team have now published in the Journal of the American Medical Directors Association clarifies something crucial: paratonia is neurological, not intentional. It is the dementia itself speaking through the body.
Paratonia causes involuntary muscle resistance during movement and care. As dementia progresses, individuals experience increasing muscle stiffness and posturing that interferes with mobility, bathing, dressing, feeding and comfort. The condition can contribute to pain, skin breakdown, and distress during care interactions for both the person receiving care and those supporting them. The publications, including an accompanying editorial from JAMDA Editor-in-Chief Dr. Paul Katz, emphasize that this resistance is neurological and involuntary rather than purposeful behavior.
The research addresses a significant gap in clinical awareness. Despite paratonia's prevalence in advanced dementia, it remains underrecognized in clinical practice and often misunderstood as something to work against rather than understand. Kleiner emphasized the stakes: "Paratonia has significant implications for people living with dementia, families and front-line care teams, yet awareness of the condition remains limited. Improving recognition and understanding of paratonia is an important step toward more compassionate and person-centered dementia care."
The timing of this clarification is urgent. The World Health Organization projects that the number of people living with dementia will nearly triple by 2050. That means millions more families, care teams, and individuals will face paratonia without understanding what it is. The research opens pathways toward more appropriate clinical responses and emerging treatment approaches, though researchers caution that no treatments are currently approved specifically for paratonia. The papers also discuss investigational approaches like Botulinum Toxin A and highlight the need for additional research to better understand safety, effectiveness, and broader clinical application.
What these publications accomplish, at their heart, is a reframing. They move paratonia from the realm of behavior management—something to overcome—into the realm of neurology and compassion. When a person's body stiffens, when they seem to resist care, the new understanding invites caregivers to pause and recognize what is actually happening: a symptom, not a choice. That shift in perspective transforms how care is delivered. Baycrest, affiliated with the University of Toronto, continues supporting research and clinical initiatives focused on improving quality of life for people living with dementia and their caregivers, with this new clarity offering a foundation for more person-centered approaches as the global dementia crisis grows.