Are dementia patients aware of their condition?

Family members and caregivers often ponder this question as their loved ones begin experiencing telltale symptoms like memory problems, poor judgement, confusion and behavior changes. In a similar vein, members often seek advice on the AgingCare Caregiver Forum as to why an aging parent or spouse is adamantly refusing care. For many seniors who have been diagnosed with Alzheimer’s disease or other forms of dementia, they refuse to stop driving, won’t accept in-home care and resist the idea of moving to senior living because they are unaware that they need assistance. The sad truth is that a decline in mental function essentially affects one’s ability to understand and acknowledge of the extent of one’s impairment. This leaves dementia caregivers in a tricky spot.

Anosognosia Is Not Denial of Dementia

Known as anosognosia, this lack of awareness differs from the shock and denial that many individuals and families experience following an initial dementia 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, traumatic brain injury, brain tumors, stroke, Alzheimer’s disease or other forms of dementia to truly believe that there is nothing wrong with them.

An estimated 60 percent of patients with mild cognitive impairment (MCI) and 81 percent of patients with Alzheimer’s disease exhibit some form of anosognosia. To complicate matters further, levels and areas of self-awareness vary from person to person. A senior's lack of insight into their impairment can be selective or complete, and it can pertain to their memory, general thinking skills, emotions and/or physical abilities.

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The ways in which those with anosognosia react to mentions of their deficiencies varies as well. For example, a dementia patient may experience occasional difficulty with language skills, like word-finding and vocabulary, but they may rationalize or explain away these situations with a general excuse about age-related forgetfulness or fatigue. Someone who has anosognosia regarding short-term memory problems, like forgetting to bathe, missing appointments or leaving food to burn 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. Some may even react with anger when confronted about their mental impairment, because they are fully convinced a deficit does not exist.

Caring for Someone with Anosognosia

For dementia caregivers, anosognosia can sometimes 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 convince them that they are incapable of driving, cooking or handling their finances when they don’t understand they are even ill? As with most unusual dementia behaviors, learning more about the issue can help you stay calm and find workarounds to keep your loved one safe.

“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 and competent that they may even refuse to go to doctor’s appointments, undergo neurological testing, receive medical treatments or take medications. We are all familiar with the adage “you can’t help those that won’t help themselves.” 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 that can result from anosognosia.

Sources: What Is Dementia? (; Anosognosia (; Anosognosia (