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Anosognosia and Dementia

October 29, 2020

It is very difficult to tell a loved one they are ill, especially with a debilitating condition like Alzheimer’s or another type of dementia. But what if that person could not comprehend or refused to believe their diagnosis? This lack of awareness or understanding would surely make dealing with the diagnosis even more difficult, especially for the person’s family, friends and other caregivers. Unfortunately, this challenging condition – called anosognosia – is quite common among those with dementia, some types of mental illness, stroke, brain tumors and traumatic brain injury.  

What Is Anosognosia?

Anosognosia means a person is unaware of their own illness and how it affects them. This denial or disbelief is a common symptom of certain disorders that affect the brain, including dementia.  

an elderly woman in a wheelchair outside, facing away from the camera

What Causes Anosognosia? 

Damage or other anatomical changes to certain areas of the brain can lead to anosognosia. Researchers believe deterioration in the frontal lobe may contribute because the frontal lobe plays an important role in problem-solving, memory and judgment, which all affect someone’s ability to understand the meaning and context of a diagnosis. Dementia, as well as stroke, schizophrenia, brain tumors and a variety of other conditions, can damage the frontal lobe.

In a New York Times blog, neuroscientist Dr. V.S. Ramachandran explains that when something happens to the right brain, which detects anomalies and new information and incorporates these into a person’s sense of reality, “the left brain seeks to maintain continuity of belief, using denial, rationalization, confabulation and other tricks to keep one’s mental model of the world intact.” 

Signs of Dementia with Anosognosia

If your loved one has dementia with anosognosia, they may exhibit behaviors like these:

  • Not keeping up with daily tasks, appointments or personal hygiene but insisting that they are fully capable of performing these activities independently despite clear evidence to the contrary
  • Occasional difficulty with language or memory skills with a tendency to explain away these issues, blaming forgetfulness or fatigue
  • Reacting with anger when confronted with their forgetfulness, lack of self-care or poor decision-making because they are fully convinced their impairment does not exist
  • Making up answers they believe are true, though sometimes details may be imagined, pertain to something that happened in the past or be something they heard elsewhere
  • Refusing medical evaluations, treatments and medications 

How Can Caregivers Deal With Anosognosia?

Caring for someone with dementia can already be emotionally, mentally and physically taxing. Helping those who also have anosognosia can be exceptionally difficult and frustrating. You will likely need help from your loved one’s medical providers and other caregivers, as well as information and guidance from professional Alzheimer’s and dementia therapists and organizations. 

Here are some tips for helping your loved one manage dementia with anosognosia:

  • Don’t try to convince them they have dementia. Anosognosia is not denial. It is a lack of awareness or understanding of one’s condition caused by changes in the brain. Trying to explain or insist to someone that they have dementia will likely only frustrate and upset them further. 
  • Help make their life as safe as possible. Find creative ways to stop them from potentially dangerous or damaging activities like driving, cooking, home repairs and even managing money. Maybe that means expressing interest in taking grocery trips or going on outings together, dropping off prepared meals to make their lives easier or suggesting an in-home caregiver, housekeeper or financial adviser who can help them find more time to relax or do favorite activities.
  • Work with their doctors and care team. Explain the problems your loved one is having and help the team understand that they aren’t aware of their dementia and why it won’t help to try to convince them. Work together to figure out ways to creatively provide them with the help or treatments they need without forcing them to admit there’s a problem.
  • Take a positive, encouraging approach. Be gentle, encouraging and empathetic about necessary tasks and try to provide a structured schedule for routine activities, personal care and downtime. Reduce unnecessary responsibilities by enlisting the help of fellow family members, home health aides or memory care professionals. Stay calm when working with your loved one to clean, pay bills or complete other tasks, and try to give them as much independence as possible.
  • Try to avoid confrontations or correcting them. Dementia care experts recommend stepping into your loved one’s reality rather than trying to correct them, which may be met with confusion, anxiety, fear or anger. Stress tends to make dementia symptoms worse, so explaining why doing things a certain way may be fun or beneficial for them is a better strategy than saying they can’t do things as they wish because of their condition. 
  • Learn more about dementia care techniques. Learning as much as you can about the disease from medical professionals, reputable organizations and fellow caregivers can help you face common challenges and improve you and your loved one’s quality of life. You’ll learn what to expect in various stages of the condition and how to better communicate and empathize with your loved one.  

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