Dementia

It cannot slow the underlying disease or restore lost memory, and any programme claiming to should be treated with scepticism.

It can maintain walking and balance, reduce falls, preserve independence in specific daily tasks, manage continence, and reduce the physical decline that otherwise compounds the cognitive one. In practice that is a substantial difference to quality of life.

Regular physical exercise improves physical fitness in people with dementia, but in a trial of 494 people with mild to moderate dementia it did not slow cognitive decline 3. Pooled trials suggest it may help with daily activities, although that evidence is of very low quality, and they found no clear benefit for depression 2.

It does not reverse cognitive decline. The honest position is that exercise is one of the better-supported interventions available in dementia, and that its main effects are physical and functional.

Cognitive decline in an older adult can be caused or worsened by thyroid disease, B12 deficiency, depression, medication effects, sleep apnoea, hearing loss and chronic pain.

Several of these are treatable. Assessment should exclude them before decline is attributed to a progressive dementia, and it is worth asking whether that has been done.

Carer training in how to assist safely, how to structure the day, how to manage distress, and how to protect their own health is a core component rather than an add-on.

Carers who report greater emotional stress, or who feel trapped by caring, are more likely to move the person into residential care 4.

Consistent routine, visible cues, reduced clutter, good lighting and clear labelling reduce confusion and preserve independence more reliably than most direct interventions.

These are cheap, they are within the family’s control, and they are frequently the last thing anyone suggests. Setting them up early is worth more than starting them once the difficulty is advanced.

Carer strain predicts admission to residential care, alongside the severity of the dementia, behavioural symptoms and dependence in daily activities 45. A family that is exhausted and unsupported cannot sustain care at home regardless of how well the person is managed.

So the assessment asks about the carer directly — sleep, health, isolation, and what happens if they become unwell. That conversation is part of the clinical work rather than a courtesy.

Partly, and the evidence is weaker than for older people in general. A 2021 meta-analysis of exercise programmes for people living at home with cognitive impairment found a reduction of about 30% in the rate of falls, but the effect came from a few trials, the number of people who fell did not change, and the evidence was rated low quality 6.

In care homes, a 2025 Cochrane review found that exercise may reduce the risk of falling in residents with cognitive impairment (low-certainty evidence), and that fall-prevention programmes tailored to each resident, including those living with dementia, and delivered with care staff probably reduce falls 7. The benefit of exercise does not last once it stops 7. The aim is therefore a routine the family can keep going at home.