Problems with Anosognosia: When a Loved One Doesn’t Realize They Have Senior Dementia

When we are faced with a major problem or health crisis, often, our first instinct is to bury our heads in the sand and ignore it. On one hand, this makes senses, albeit in a convoluted way. Our brain is trying to protect us from the unpleasant feelings and associations that the problem may bring. It’s also processing and adapting to this new information in order to reach a solution.
Most of us eventually accept that there is a problem and take active steps to solve it. However, for some people (like those with senior dementia), this is not so easy. They may go into denial about the issue, refusing to acknowledge and deal with it. But there are also individuals who have anosognosia, or a “lack of awareness of impairment.” Studies have shown that this may affect up to 81% of those with Alzheimer’s disease.[1. “A diagnostic formulation for anosognosia in Alzheimer’s disease,” March 20, 2006,]

Facts about Anosognosia

Anosognosia is more than just a coping mechanism, like denial. Denial is the result of cognitive function, which suggests that areas of the brain that process information are still working (although in a roundabout way, as we mentioned). Anosognosia, on the other hand, is the result of physical damage to the part of the brain that affects perception.
This can create difficulties for caregivers, especially when they try and offer help to someone who is anosognosic. The person may insist they can complete tasks on their own when they clearly can’t. Some of these tasks are dangerous, such as operating a car or pair of scissors. But they can be as mundane as failing to take their medications as prescribed—or at all. However, working around anosognosia is key, because many times the help or treatment refused are the very ones the patient needs to survive.

How to Cope with Your Loved One’s Anosognosia

With denial, there are various methods you can employ to help the person cope with their illness.[2. “Dealing with Denial,”] Some of these are very direct (for example, you may have heard of the “intervention” method when bringing a person face-to-face with their alcohol or drug use). Others are more subtle, seeking to address the underlying fear that keeps the individual from admitting their problem.
However, these methods are unlikely to be effective with anosognosia. That’s because the victims may not be mentally capable of acknowledging their issue—ever. And although that may seem like an insurmountable barrier to coping with the illness, it’s actually not. As long as you are aware of your loved one’s condition and are taking steps to treat it, there are ways to deal with the day-to-day stress anosognosia can bring. These ways include:
Keeping your communications positive: When your loved one has trouble with tasks or accepting help, be kind and empathetic when offering assistance.
Making joint tasks part of the everyday routine: Your loved one may be more inclined to accept help if it becomes normalized. For instance, start making a habit of going grocery shopping together every week, rather than asking if your mom needs help because she’s not supposed to go alone.
Being subtle when bringing up concerns: Language such as “Let me help you cook on the stove; you know I love being in the kitchen with you,” works better than “You can’t do that by yourself anymore—you’ll get hurt!”
Getting professional help: When caregiving tasks become too overwhelming, don’t hesitate to seek the services of a home health agency. They can provide staff with experience in dementia, anosognosia, and more.

Stay Positive when Someone You Love Has Senior Dementia

Although coping with senior dementia and anosognosia can be an exercise in frustration, it’s important to stay positive. By understanding the condition, as well as using the tips and tricks above, you can help keep your loved one safe—whether or not they’re aware it’s something they need.
If you are unsure of how to best help an aging loved one, the trained and compassionate staff at the Institute on Aging is here to help you make that decision and gain the best in at-home care for older adults. Contact us to find out more.

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