Hidden muscle resistance in advanced dementia is involuntary, not refusal, new papers explain

by Baycrest Centre for Geriatric Care

edited by Gaby Clark, reviewed by Andrew Zinin

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Baycrest researchers and clinicians have contributed to newly published research advancing understanding of paratonia, a common but often underrecognized condition affecting people living with advanced dementia.

Published in the Journal of the American Medical Directors Association, the papers explore the clinical features of paratonia, approaches to recognition and assessment, and broader considerations related to research and emerging treatment approaches.

"Paratonia has significant implications for people living with dementia, families and front-line care teams, yet awareness of the condition remains limited," said Dr. Galit Kleiner, a neurologist and researcher at Baycrest and senior author on the publications. "Improving recognition and understanding of paratonia is an important step toward more compassionate and person-centered dementia care."

Paratonia causes involuntary muscle resistance during movement and care. As dementia progresses, individuals may experience increasing muscle stiffness and posturing that can interfere with mobility, bathing, dressing, feeding and comfort. The condition also may contribute to pain, skin breakdown and distress during care interactions for both individuals receiving care and those supporting them.

Despite its prevalence in advanced dementia, paratonia remains underrecognized in clinical practice and may sometimes be misunderstood as purposeful resistance to care or behavioral symptoms. In an accompanying editorial, JAMDA Editor-in-Chief Dr. Paul Katz highlighted the importance of improving awareness and clinical recognition of paratonia in dementia care.

The research highlights that paratonia-related resistance during care is neurological and involuntary rather than intentional behavior, helping support more clinically appropriate and compassionate approaches to care delivery.

The publications also discuss investigational treatment approaches and the need for additional research to better understand safety, effectiveness and broader clinical application. Researchers caution that no treatments are currently approved specifically for paratonia and that further study is needed.

Baycrest researchers say growing awareness and understanding of paratonia will become increasingly important as the number of people living with dementia continues to rise globally and is projected to nearly triple by 2050, according to the World Health Organization.

Baycrest, affiliated with the University of Toronto, continues to support research and clinical initiatives focused on improving quality of life and care experiences for people living with dementia and their caregivers.

More information

Paratonia in Advanced Dementia: A Frequently Misunderstood Movement Disorder, Journal of the American Medical Directors Association (2026). DOI: 10.1016/j.jamda.2026.106284

Galit Kleiner et al, Paratonia in Advanced Dementia: Deconstructing Scientific, Regulatory, and Health System Barriers to Botulinum Toxin A (BoNT-A) Treatment of Involuntary Muscle Resistance, Journal of the American Medical Directors Association (2026). DOI: 10.1016/j.jamda.2026.106285

Key medical concepts

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NeurologyGeriatric palliative careHealthy aging Provided by Baycrest Centre for Geriatric Care Who's behind this story?

Gaby Clark

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