Paratonia in Advanced Dementia: A Frequently Misunderstood Movement Disorder

Paratonia is a movement disorder characterized by involuntary muscle stiffening that affects nearly all individuals with advanced dementia, yet it remains poorly recognized in routine clinical practice. Often misinterpreted as intentional resistance to care, untreated paratonia may progress to muscle contractures with secondary consequences, including pressure injuries, pain, and difficulty with caregiving. This clinical review provides clinicians with practical guidance in recognizing paratonia as a reflexive phenomenon rather than a behavioral disturbance. Three illustrative cases demonstrate presentations across care settings and clinical presentations. The article addresses bedside assessment, medications to avoid, indications for specialist referral, and both pharmacologic and nonpharmacologic management options.