Anosognosia: When Dementia Patients Can’t Recognize Their Impairment

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One of the most common questions in the AgingCare.com Alzheimer’s and Dementia Support Group pertains to how aware dementia patients are of their cognitive status. This can pose a bit of a dilemma, because with reduced mental function, there also comes a limited capacity for insight into and acknowledgement of their true condition.

Anosognosia Is Not Denial

Known as anosognosia, this phenomenon differs from the shock and denial that many individuals and families experience following an initial diagnosis. The word anosognosia is composed of three Greek roots, which combine to mean “without knowledge of disease.” Changes in the brain cause individuals with mental illness, brain tumors, stroke, Alzheimer’s disease and other forms of dementia to believe that there is nothing wrong with them.

A loved one’s lack of awareness of their impairment can be selective or complete, and it can pertain to their memory, general thinking skills, emotions and physical abilities. A dementia patient may experience occasional difficulty with language skills, like word-finding and vocabulary, but they may explain away these situations with a general excuse about forgetfulness or fatigue. Someone who has anosognosia regarding short-term memory problems, like forgetting to bathe, missing appointments, or leaving food on the stove, will typically insist that they do not need help and are fully capable of performing daily activities independently despite clear evidence to the contrary. They may also react with anger when reminded of their mental impairment, which they are fully convinced does not actually exist.

Caregiving and Anosognosia

For dementia caregivers, anosognosia can be more frustrating to deal with than a loved one’s actual lapses in memory. A senior’s abilities are changing before your eyes, but how can you convey that they are incapable of driving, cooking or handling their finances when they don’t understand they are ill? As with most unusual dementia behaviors, learning more about the issue can help you stay calm and find workarounds.

“My mother has anosognosia—something I didn't even know existed until I read an article about it a couple of years ago. Just knowing that she lacks the capability to recognize her deficits does make it easier to work with her sometimes because I can strategize with that in mind.” –caregiverforum1

Some patients are so convinced they’re healthy that they may even refuse medical evaluations, treatments and medications. We are all familiar with the phrase you can’t help those that won’t help themselves. But with dementia, even when someone does not acknowledge the root of their problems or want assistance, intervention of some kind is usually necessary.

Visit the articles below for insights and suggestions from experienced caregivers on how to cope with the complications and lack of awareness that result from anosognosia.

Ashley Huntsberry-Lett

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Ashley is responsible for the planning and creation of AgingCare.com’s award-winning content. As a teenager, she assisted in caring for her step-father during his three-year battle with colon cancer. Now, through her work at AgingCare.com, she strives to inform and empower the caregivers who devote so much to helping and healing the ones they love.

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6 Comments

I think my Dad is different from the usual dementia. Since there is a very specific physical reason for it. Hydrocephalus.

Some days he is very aware. He might not remember it for long..but, he knows. He asks why this is happening to him. He asks how it is possible for him to no know where his own bathroom is? He knows. Then, a day later he doesn't know.

I think in many ways it is more heartbreaking because my Dad pops through every so often.
Wow, fantastic article, and I really learned a lot! My FIL who lives with us has recently failed the 1sr mini mental examination, so we know that we are in for a rough road ahead. I'm so glad to have read this article, to know some of the signs to look for, and how to deal (a little), with them!
Anosognosia is something I am very familiar with. My mother has significant cognitive decline, but thinks that she is fine. She has been diagnosed with dementia, but she does not acknowledge it. She sometimes admits that she has trouble with her memory, than other times she says she remembers everything. She tells me that I try to act like she's forgotten, but that she knows everything that happened.

Anosognosia is very difficult for a caregiver. For example, tonight my mother was talking about some chairs I gave away 3-4 years ago. She said that I should have asked her before giving them away. I told her I had, but then said she remembered everything perfectly and I had not asked her.

When things like this happen every day, it is like there is no reality at all. If I mention memory loss or confusion, it is met with a very angry "I'm not crazy!" When I read stories such as the one Jeanne wrote about her husband, I think of how much easier it would be if I could say something like "It's just ole dementia acting up." If I did that, there would be no peace. :-O