{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:12:44Z","timestamp":1790161964028,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Paratonia is an involuntary and variable resistance to passive movement that emerges with cognitive decline in dementias of different etiologies, with prevalence approaching 90% to 100% in end\u2010stage disease. It is common in Parkinson disease and the atypical parkinsonisms. The involuntary resistance is frequently interpreted as volitional refusal of care and may be managed with psychotropic medication. We propose that paratonia meets the criterion by which a movement disorder is defined, with a reproducible and distinct clinical phenomenology that is operationalized in a validated bedside instrument and is distinguishable from parkinsonian rigidity, spasticity, and dystonia. We present a preliminary staging schematic in which treatment with botulinum toxin A (BoNT\u2010A) is indicated when the posturing interferes with care and the contraction remains dynamic, before fixed contracture. Preliminary evidence from a randomized pilot trial and observational studies supports BoNT\u2010A for care\u2010interfering paratonia. Classification of paratonia as a movement disorder would enable a dedicated research, education and advocacy platform to advance clinical care.<\/jats:p>","DOI":"10.1002\/mdc3.70836","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:34:32Z","timestamp":1790159672000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Should Paratonia Be Considered a Movement Disorder? Implications for Clinical Management"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5261-2509","authenticated-orcid":false,"given":"Galit","family":"Kleiner","sequence":"first","affiliation":[{"name":"Austin Centre for Neurology and Behavioral Supports Baycrest Health Sciences  Toronto ON Canada"},{"name":"Katz Interprofessional Research Program in Geriatric Dementia Care, Rotman Research Institute  Toronto ON Canada"},{"name":"Division of Neurology, Department of Medicine University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8077-8530","authenticated-orcid":false,"given":"Christos","family":"Ganos","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine University of Toronto  Toronto ON Canada"},{"name":"Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University Health Network  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1229-3667","authenticated-orcid":false,"given":"Anthony E.","family":"Lang","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine University of Toronto  Toronto ON Canada"},{"name":"Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University Health Network  Toronto ON Canada"},{"name":"Edmond J. Safra Program in Parkinson's Disease and Rossy PSP Centre, Toronto Western Hospital University Health Network  Toronto ON Canada"},{"name":"Krembil Brain Institute  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"issue":"2","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1519\/00139143-200608000-00002","article-title":"Paratonia: a Delphi procedure for consensus definition","volume":"29","author":"Hobbelen JS","year":"2006","journal-title":"J Geriatr Phys Ther"},{"issue":"4","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.3233\/JAD-200691","article-title":"Paratonia in dementia: a systematic review","volume":"78","author":"Drenth H","year":"2020","journal-title":"J Alzheimer's Dis"},{"issue":"1","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jns.2009.08.034","article-title":"The epidemiology of dementia associated with Parkinson disease","volume":"289","author":"Aarsland D","year":"2010","journal-title":"J Neurol Sci"},{"issue":"7","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2026.106284","article-title":"Paratonia in advanced dementia: a frequently misunderstood movement disorder","volume":"27","author":"Perri GA","year":"2026","journal-title":"J Am Med Dir Assoc"},{"issue":"7","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2026.106286","article-title":"Charting a new course in the diagnosis and treatment of paratonia","volume":"27","author":"Katz PR","year":"2026","journal-title":"J Am Med Dir Assoc"},{"issue":"7","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jamda.2026.106285","article-title":"Paratonia in advanced dementia: deconstructing scientific, regulatory, and health system barriers to botulinum toxin a (BoNT\u2010A) treatment of involuntary muscle resistance","volume":"27","author":"Kleiner G","year":"2026","journal-title":"J Am Med Dir Assoc"},{"key":"e_1_2_10_8_1","article-title":"Surmountable caregiver barriers to paratonia treatment in community\u2010dwellers with dementia: a cross\u2010sectional survey","author":"Kleiner G","year":"2026","journal-title":"Can J Neurol Sci"},{"key":"e_1_2_10_9_1","unstructured":"World Health Organization.Dementia; Fact sheet. 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