Some of the most common questions in the AgingCare Caregiver Forum are based on the premise that an aging parent or spouse is refusing care because they are unaware that they are in need of assistance. This brings to question whether a senior diagnosed with Alzheimer’s or other dementia is able to recognize their own cognitive status. For many alzheimer's and dementia caregivers, this can pose a bit of a dilemma. When alzheimer's is coupled with anosognosia, there also comes a limited capacity for insight into and acknowledgement of the true ability to perform activities of daily living.
Anosognosia Is Not Denial
Known as anosognosia, this lack of awareness 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 truly believe that there is nothing wrong with them.
A senior'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, because they are fully convinced a deficit 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.”
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.