Have you noticed your loved one leaning to one side while sitting or walking? Maybe they seem to tilt without realizing it, and you find yourself wondering why. This is more than just a sign of aging or posture changes. It could be something called Pisa Syndrome, a condition named after the Leaning Tower of Pisa because of how dramatically it causes a person to lean to one side.
Pisa Syndrome is not very common, but when it does happen, it can make daily life and caregiving much more difficult. In this post, we’ll talk about what Pisa Syndrome is, how it shows up in dementia and Parkinson’s disease, what medications might cause it, and most importantly, what you can do to help your loved one feel safer and more comfortable.
What Is Pisa Syndrome?
Pisa Syndrome causes a person’s upper body to lean noticeably to one side. The lean is usually most visible when the person is sitting or walking and may improve when they lie down flat. It can come on gradually or suddenly, and it can be painful or affect balance and coordination. For a caregiver, it can make tasks like dressing, bathing, and helping your loved one move around much harder.
Doctors typically diagnose Pisa Syndrome through direct observation, meaning they watch how the person walks and sits. Some may also use imaging or review medication lists to find a cause.
Although Pisa Syndrome can appear in people with dementia, it’s most commonly seen in individuals who have Parkinson’s disease. It can also be triggered or worsened by certain medications.
How Common Is Pisa Syndrome?
While Pisa Syndrome isn’t one of the most common symptoms you’ll encounter, it’s not rare either—especially for people with Parkinson’s. Studies show that about one in ten people with Parkinson’s disease develop Pisa Syndrome. In these cases, the cause is often tied to changes in the brain related to Parkinson’s itself.
The condition affects a part of the brain called the basal ganglia, which helps control movement and balance. When this area is affected, the body can begin to lean to one side, almost as if pulled by an invisible force.
However, Pisa Syndrome can also happen because of medication side effects, even in people who don’t have Parkinson’s. Understanding this connection is important because, in some cases, the solution might be as simple as adjusting a medication under a doctor’s supervision.
Medications That Can Cause Pisa Syndrome
A 2024 study looking at 191 cases of Pisa Syndrome found that several types of medications were linked to its development. These include:
Alzheimer’s medications, such as donepezil (commonly known by its brand name, Aricept)
Antipsychotics, often prescribed for agitation, aggression, or severe mood changes
Certain Parkinson’s medications, especially when used over long periods
In more than half of the reported cases, Pisa Syndrome began within one month of starting or changing a medication.
The good news is that when the medication was reduced or discontinued, many people improved or fully recovered from the leaning. This shows just how important it is to review medications carefully especially when you notice new or unusual physical changes.
If your loved one is showing signs of Pisa Syndrome, do not stop or change any medication on your own. Instead, bring your observations to their healthcare provider right away. Sudden medication changes can cause other serious side effects or complications.
What to Do if You Notice Pisa Syndrome
If you notice your loved one leaning to one side, even slightly, take note of when and how it happens. Do they lean only when sitting? Does it worsen as the day goes on? Does it improve when they lie down? Small details like this can help the doctor pinpoint whether the cause is neurological, muscular, or medication-related.
Here’s what you can do:
1. Talk to the Doctor
Start by describing exactly what you’ve noticed. A video recording can be very helpful for showing what happens at home. The doctor may order an evaluation to rule out medication side effects, muscle weakness, or progression of dementia or Parkinson’s disease.
2. Review All Medications
Ask the doctor or pharmacist to review every prescription, supplement, and over-the-counter medication your loved one takes. Even drugs that seem unrelated to dementia can cause side effects that affect movement and balance.
If the doctor suspects medication might be contributing, they may lower the dose, switch to a different drug, or stop the medication entirely. In many cases, this simple change can dramatically reduce the leaning or even eliminate it.
3. Request Physical and Occupational Therapy
If Pisa Syndrome is due to brain changes rather than medication, therapy can make a big difference.
Physical therapists can help your loved one work on posture, balance, and strength, especially in the core muscles that support stability.
Occupational therapists focus on helping your loved one perform daily activities more safely. Despite the name, “occupational” therapy has nothing to do with work—it’s about making everyday life easier and more functional. They can recommend adaptive equipment, special seating, and strategies for safer eating, dressing, or bathing.
4. Make the Home Safer
Because Pisa Syndrome affects balance, it increases the risk of falls. You can reduce hazards by:
Removing clutter and loose rugs
Installing grab bars in bathrooms
Ensuring furniture is sturdy and within easy reach
Keeping walkways well lit
A few small adjustments can make a big difference in preventing injuries.
5. Ask About Advanced Options
In rare and severe cases, doctors may discuss a surgical procedure called deep brain stimulation (DBS). This involves placing electrodes in certain brain areas to help regulate movement. While DBS is more common for advanced Parkinson’s disease, it’s not usually recommended for people with dementia.
How Pisa Syndrome Impacts Daily Life
Pisa Syndrome affects much more than posture it can change how your loved one interacts with the world. The leaning can make it hard to eat without spilling food, sit comfortably in a chair, or maintain balance while walking. Over time, this can lead to muscle pain, frustration, or even embarrassment.
For caregivers, this adds another layer of physical and emotional strain. Helping with transfers, dressing, or mobility can become more challenging. That’s why recognizing Pisa Syndrome early and addressing it promptly is so important.
Remember, even if it feels small at first, a noticeable lean is not normal aging. It’s a sign that something is happening in the body or brain that deserves attention.
How to Talk to the Doctor About Pisa Syndrome
Many caregivers hesitate to bring up changes like leaning or posture shifts, thinking they might just be minor or temporary. But your observations are often the first clue that something deeper is going on.
When you contact your loved one’s healthcare provider, try to include:
- When you first noticed the leaning
- Whether it’s getting worse or staying the same
- Which direction they lean
- Any recent medication changes
- Whether they complain of pain or dizziness
This information helps the medical team decide whether to order imaging, refer to therapy, or adjust medications.
Key Takeaways for Dementia Caregivers
Pisa Syndrome causes the upper body to lean significantly to one side.
It’s most often linked to Parkinson’s disease or certain medications.
Medication adjustments, therapy, and safety modifications can all help.
Always discuss new symptoms with a doctor before making any changes.
You are often the first to notice early signs—your role is essential.
Pisa Syndrome can look frightening, but once you know what it is, you can act with confidence and calm. With proper evaluation and care, many people improve, and caregivers often feel a huge sense of relief knowing what’s happening and why.
You’re Not Alone on This Journey
Dementia caregiving is filled with unexpected challenges, from medical mysteries like Pisa Syndrome to emotional hurdles that test your strength. If you’d like ongoing support, encouragement, and expert guidance, join the Dementia Dose, my free weekly newsletter for family caregivers.
Each week, I share insights, practical strategies, and emotional support to help you feel more confident and less alone. You can sign up by clicking here.
You don’t have to face this journey alone. Let’s walk it together, one informed, supported step at a time.
If you’re curious to learn more, several studies dive deeper into how our brains age and what helps keep them healthy. For instance, one study on early cognitive decline and another on memory and aging both explore important lifestyle factors. There are also recent clinical findings and neuroscience-based insights that highlight practical ways to support brain health over time.
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