Dementia affects motor coordination primarily by disrupting the brain regions and neural pathways responsible for planning, initiating, and controlling movement. This impairment arises because dementia involves progressive neurodegeneration that impacts both cognitive and motor systems, leading to difficulties in executing coordinated physical actions.
Motor coordination depends on the integrated function of multiple brain areas, including the motor cortex, premotor cortex, supplementary motor area (SMA), basal ganglia, cerebellum, and their connections with cognitive centers such as the prefrontal cortex. In dementia, especially in conditions like Alzheimer’s disease and vascular dementia, these regions suffer from neuronal loss, synaptic dysfunction, and disrupted connectivity, which collectively degrade motor control.
Research shows that older adults with cognitive frailty—a condition often preceding or accompanying dementia—exhibit altered brain activation patterns during tasks requiring simultaneous cognitive and motor effort. For example, during cognitive-motor tasks, these individuals activate motor- and cognitive-related brain areas (bilateral prefrontal cortex, SMA, premotor cortex) more than healthy controls, yet their performance declines on more complex tasks. This suggests that although their brains attempt to compensate by increasing activity, the efficiency of neural resource utilization is reduced, leading to poorer motor coordination outcomes [1].
Dementia-related motor coordination deficits manifest as slowed movements, impaired balance, reduced fine motor skills, and difficulties with gait and posture. These symptoms arise because dementia affects:
– **Motor planning and execution:** Damage to the premotor cortex and SMA impairs the ability to plan and sequence movements.
– **Muscle strength and control:** Neurodegeneration can reduce lower extremity muscle strength, contributing to instability and coordination problems.
– **Sensory integration:** Impaired proprioception and multisensory processing hinder the brain’s ability to accurately perceive body position and movement, essential for coordination [2].
Interventions combining cognitive and motor stimulation, such as psychomotor training, have shown promise in improving motor skills and cognitive functions in early dementia stages. These programs focus on body awareness, postural control, balance, joint stability, proprioception, and motor imagery, which help maintain or enhance motor coordination by engaging both cognitive and motor neural circuits [2].
Moreover, dual-task training that integrates cognitive challenges with physical activity, sometimes enhanced by virtual reality technology, has demonstrated significant improvements in cognitive and motor functions in individuals with mild cognitive impairment (MCI), a precursor to dementia. Such training may enhance neuroplasticity and improve the brain’s ability to manage complex motor tasks under cognitive load, thereby mitigating coordination deficits [3].
Primitive reflexes, which are automatic motor responses present in infancy but typically inhibited in adulthood, tend to re-emerge in dementia and cognitive aging. Their presence correlates strongly with lower cognitive functioning and impaired motor control. Physical activity appears to mediate this relationship, suggesting that maintaining an active lifestyle can help preserve motor coordination and cognitive function despite neurodegeneration [4].
In summary, dementia disrupts motor coordination through neurodegenerative changes affecting motor and cognitive brain regions, leading to inefficient neural processing and impaired movement control. Therapeutic approaches that combine cognitive and motor training, including psychomotor exercises and dual-task interventions, can help improve or maintain motor coordination by enhancing brain function and compensatory mechanisms.
Sources:
[1] PMC12641007
[2] PMC12626226
[3] JMIR 2025;1:e79274
[4] Front. Aging Neurosci. 2025;10.3389/fnagi.2025.1687512
