Anosognosia and Dementia

Family caregivers are often frustrated by the confusing and seemingly "stubborn" behaviors of a loved one with dementia. For some, this frustration stems from the difficulties in dealing with a loved one who doesn't even realize they have Alzheimer's or dementia. This challenging phenomenon is called anosognosia.

What is Anosognosia?

According to the National Alliance on Mental Illness, anosognosia is when a person is unaware of their own condition or unable to perceive their condition accurately despite evidence to the contrary. When it comes to dementia, one might compare the experience to dealing with someone who is unable to remember that they can't remember.

Dementia Denial

Anosognosia is not the denial of dementia, it is a true lack of awareness of the condition. There is a difference between denying the reality of a diagnosis and being unaware of the decline in cognitive skills. Think of denial as more of a conscious choice, whereas anosognosia is the lack of insight or ability to process the information that a person's cognition, memory and behaviors have changed.

Are Any Dementia Patients Aware of Their Diagnosis?

Although family members are often the first to notice changes in memory or behavior, some seniors do recognize the initial declines that spur them to get diagnosis and treatment. As declines in thinking and reasoning progress, a dementia patient's awareness and acceptance of their diagnosis can differ- sometimes on a daily, weekly or even hourly basis. A study performed by Spaletta et al. regarding a patient's adaptation to their dementia diagnosis identifies the true dangers of anosognosia. Not only are seniors with anosognosia unaware of their deficits, they also cannot recognize their limitations in activities of daily living. When patterns of behavior, household routines and social interactions are not adapted to a new, more limited level of functioning there are often negative consequences. Elders with anosognosia push to continue independently performing activities like driving, managing finances, cooking, or living alone without recognition that their impaired abilities may now present a danger to self or others.

Should You Remind Someone They Have Dementia?

The heartache of caring for someone with dementia is often accompanied by the stress of trying to convince them of the how’s and whys things have changed. The repetitive questions about why Dad can no longer drive or why Mom can't return to her long-time home are even more challenging when attempting to reason with a person who is completely unaware of their deficits. Seniors with dementia lose the ability to reason; seniors with anosognosia can't recognize that they're being unreasonable because they don't understand that anything is wrong. No amount of convincing or telling is going to break through this lack of self-awareness.

Anosognosia May Lead to Treatment Refusal

Unfortunately, one of the more frustrating behaviors that accompanies anosognosia is the refusal of help. Those who lack self-awareness into their changes in cognition also lack awareness that there is a need for diagnosis, treatment or medication. More so, those who lack awareness in their changes in functioning often refuse the help they need to continue to function safely. A senior with dementia is sometimes the only person unable to recognize their deficits. Once family members and physicians agree that a loved one no longer has the capacity to make decisions on their behalf, families can turn to power of attorney or guardianship in order to put the help a loved one needs in place to maintain their health and safety.