Anosognosia: How To Talk To Someone Who Doesn't Realize He Has Dementia

Anosognosia: How To Talk To Someone Who Doesn't Realize He Has Dementia

Technically speaking, anosognosia is the lack of awareness or lack of insight, mainly pertaining to those who suffer from dementia or Alzheimer's disease. It is quite common, and one study has shown that after a stroke up to 77% of patients suffer from this at least temporarily. It occurs quite frequently in those that suffer mental illness as well. Alzheimer’s and Dementia care involves recognizing that the individual may not consciously know what is happening, and knowing how to engage with such an individual is important.

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Causes of Anosognosia

It is still very difficult to define, but research has shown that anosognosia results from physical/anatomical changes or damage to the brain where the perception of one's own illness is controlled. Our brains are wired to detect new information and anomalies, and then incorporate this information into our sense of reality. When something like a stroke, traumatic brain injury, or Alzheimer’s disease damages this area of the brain, it still tries to maintain its own mental model of the world as it was before injury, using rationalization, denial, and confabulation. The individual lacks insight into their current state of being.

Alzheimer's Disease or Anosognosia

Anosognosia can occur in conjunction with dementia or other cognitive impairments. Studies have estimated that 81% of people with Alzheimer's have some form of anosognosia, and 60% of people with mild cognitive impairment also live with this condition. This is quite difficult for caregivers as they are trying to help someone who cannot acknowledge their own illness. The person will have obvious problems with routine tasks but will maintain that they do not need help and may even refuse medical evaluation and treatment.

Denial or Anosognosia?

Anosognosia can be selective or complete, making the situation even more of a challenge. The affected individual can be completely unaware of their impairment and can react with anger and defense when confronted about it. This makes it difficult to diagnose anosognosia, and hard to differentiate it from denial. These are some signs you can look for if concerned that a loved one might be facing dementia with anosognosia:

  • They may not be keeping up with their regular daily tasks and personal hygiene.
  • It may be difficult for them to maintain bills and money.
  • They may be less inhibited or more spontaneous in conversations with little concern for their own behavior.
  • They may be more spontaneous in general.
  • They may become angry when confronted with their forgetfulness, poor decision-making, or lack of care.
  • They may begin making up situations that they believe are true with details being imaginary even when the discussion is pertaining to real events from the past.

Alzheimer’s disease care involves seeking assistance to diagnose the suspected problem, and creating a plan of action to be sure the person remains safe and healthy, while maintaining dignity and social engagement.

What to do if a loved one does not know they have dementia

As a caregiver, the most effective strategy is mitigating the effects as opposed to trying to make the person understand. Trying to make someone with dementia understand they have changed will only lead to frustration. Some useful approaches are:

  • Communication that is gentle, encouraging, and empathetic.
  • A schedule of tasks, personal care, and downtime should be structured in a way that you or another caregiver from the home can help.
  • Unnecessary responsibilities should be downsized.

Work together with the senior who has Anosognosia due to Alzheimer’s disease. Be caring, be supportive, and assist with performing necessary tasks such as money management, organizing, or cleaning around the house. Remember to stay focused and calm when voicing concerns about the individual. Convey your thoughts in a tone that is positive and light. It is likely that they may never realize that they have an illness, so it is a waste of time trying to force understanding on them.

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