Lewy Body Dementia, Falls and Fainting: What Families Should Check

Why are falls more common in Lewy body dementia?

Lewy body dementia can affect movement, balance, attention and the way the brain interprets what the eyes see. A person may move more slowly, become stiff, shuffle, misjudge a step or obstacle, or have a sudden change in alertness. These factors can combine, so a fall may not have one simple cause.

The condition can also affect automatic body functions, including blood-pressure control. Blood pressure may fall when the person stands up, causing light-headedness, blurred vision, weakness or fainting. Clinicians call this postural or orthostatic hypotension.

A fall, faint and unresponsive spell are not the same thing

A fall means the person unexpectedly comes to the ground. A faint is a brief loss of consciousness, often with a quick recovery. A Lewy body fluctuation can look like staring, drowsiness or reduced responsiveness without a typical faint. Families may not be able to tell which happened, and that is a reason to seek assessment rather than guess.

Write down what occurred before, during and after the event. Useful details include whether the person had just stood up, felt dizzy, went pale, lost consciousness, jerked, hit their head, had chest pain, recovered fully and how long the episode lasted.

What should the GP or clinical team review?

Tell the GP about every faint and about repeated falls. Ask for a review of blood pressure lying and standing, medicines, hydration, eyesight, footwear, mobility and any heart or neurological symptoms. Some blood-pressure, sleep, pain or Parkinson’s medicines can add to dizziness or drowsiness, but never stop a prescribed medicine without advice.

A physiotherapist or occupational therapist may assess walking, transfers, equipment and home hazards. A local-authority care needs assessment can also consider practical help and changes that make the home safer.

Small safety changes that may reduce risk

Use changes that fit the person rather than trying to remove every risk from daily life.

• Encourage the person to sit on the edge of the bed or chair before standing
• Keep frequently used routes bright and clear of loose rugs, cables and clutter
• Use supportive, well-fitting footwear and make sure glasses are available
• Place a stable chair where dizziness commonly occurs, such as near the bathroom
• Keep drinks visible and offer them regularly unless a clinician has advised fluid restriction
• Ask for professional advice before buying walking aids or bed rails
• Make a plan for how to call for help after a fall

What to do after a fall

Do not rush to lift the person. Check whether they are responsive, breathing normally and in pain, and look for a possible head, back, neck or hip injury. Keep them warm and comfortable while you get advice. If they may be injured or unwell, contact NHS 111; call 999 if they cannot get up or may have seriously injured their head, back, neck or hip.

Even when there is no obvious injury, tell the GP about a first fall, recurring falls, worsening balance or a faint. A pattern review can be more useful than simply adding more supervision.

When to call 999

Call 999 if the person is not breathing, cannot be woken within one minute, has not recovered fully, has new difficulty speaking or moving, has chest pain or palpitations, has a seizure, has a serious injury, or shows stroke symptoms. Do not assume an unresponsive episode is a normal Lewy body fluctuation until urgent causes have been considered.

A sudden change in balance or alertness alongside new confusion, fever or illness also needs prompt medical advice. Infection and delirium can sharply increase falls in someone who was previously steadier.

The bottom line

Lewy body dementia can increase falls and fainting through movement, visual-perception, alertness and blood-pressure changes. The diagnosis explains why risk may be higher; it does not explain every new event.

Record the pattern, ask for a medicines and falls review, make proportionate home changes and seek urgent help for loss of consciousness, incomplete recovery, stroke signs or serious injury.