Wrong dementia diagnosis: how physiotherapy restored dignity to an elderly man

By Leticia Profeta, Physiotherapist

One of the most impactful experiences of my career was discovering that a patient diagnosed with dementia was, in fact, fully conscious - only limited by lack of mobility and adequate stimuli. This story illustrates the crucial importance of independent physiotherapy assessment and how it can completely transform a person's quality of life.

The Call: a "demented" bedridden patient

I was called to attend a patient at home who had:

• Medical diagnosis: Dementia

• Current condition: Bedridden for 2 years

• Recurrent admissions: Recurring urinary tract infections

• Physical state: Severe muscle loss, very thin

• Profession: Paediatric doctor

The initial scenario was challenging: an elderly man who apparently didn't respond adequately, treated by the family as someone with severe cognitive impairment.

The physiotherapy assessment: discovering the truth

During my detailed assessment, something didn't make sense. I observed signs that contradicted the dementia diagnosis:

Warning signs I identified:

• Attentive and responsive gaze

• Appropriate reactions to stimuli

• Understanding of simple commands

"My conclusion: this patient didn't have dementia. He was cognitively preserved, only limited by a diagnosis given at the time of admission when the patient was confused and agitated due to urinary tract infection."

The treatment: function-focused physiotherapy

We began an intensive home physiotherapy programme with clear objectives:

Phase 1: Strengthening in Bed

• Passive and active assisted exercises

• Joint mobilisation

• Stimuli for muscle activation

Phase 2: Transitions

• Training to sit on edge of bed

• Trunk strengthening

• Sitting balance

Phase 3: Functional Mobility

• Transfer training

• Standing with support

• First assisted steps

Extraordinary results

Within a few weeks, the transformations were evident:

Mobility Recovered

• Returned to walking with support

• Got up from bed independently

• Walked to the sitting room

Independence in Daily Activities

• Shower bathing (previously only bed bathing)

• Started using the toilet and no longer depending on nappies

• Fed himself in the sitting room

Social Reintegration

• Interaction with family

• Played with grandchildren

• Watched his favourite TV programmes

• Read newspapers daily

The drama of wrong diagnosis

The most touching part of this story was realising the psychological suffering this gentleman faced:

"Imagine being fully conscious, understanding everything around you, but being treated as if you understood nothing."

What he endured daily:

• People talking about him in front of him

• Being treated as mentally incapable

• Decisions made without his participation

• Total loss of dignity and autonomy

Fundamental lessons for families and professionals

1. Question diagnoses when necessary

The initial medical diagnosis isn't always complete. Physiotherapy assessment can reveal important functional aspects.

2. Immobility can simulate dementia

Immobilisation syndrome can cause:

• Apathy

• Reduced responsiveness

• Social isolation

• Apparent cognitive decline

• Pressure ulcers

• Mental confusion

3. Importance of multidisciplinary assessment

Each professional offers a unique perspective that can be crucial for correct diagnosis.

4. Preserved dignity

Always treat elderly people with respect, regardless of diagnosis - they may be understanding much more than they appear to.

Warning signs: when to question a diagnosis

Seek a second opinion if you observe:

• Very rapid functional decline

• "Dementia" after period of immobilisation

• Responsive gaze in "demented" patient

• Improvement with physical stimuli

• Inconsistencies in behaviour

The power of home physiotherapy

This case demonstrates how home physiotherapy can:

✅ Identify incorrect diagnoses

✅ Restore function and dignity

✅ Improve family quality of life

✅ Reduce hospital admissions

✅ Provide patient-centred care

Final message

This experience taught me that our responsibility goes beyond exercises - we are advocates for our patients, questioning when necessary and fighting for their dignity and quality of life.

Do you have an elderly family member with a dementia diagnosis and functional loss? An independent physiotherapy assessment may reveal unexpected possibilities.

About the Author

Leticia Profeta is a physiotherapist who dedicates herself to providing patient-centred care and careful assessments that respect the dignity of each patient.

Need home physiotherapy assessment? Get in touch today.

This article is based on real clinical experience and is for educational purposes. Always seek qualified professional assessment for specific cases.