The top warning signs of anosognosia


Dementia is heartbreaking for many reasons. Unlike a broken bone, high blood pressure or other chronic illness, there is no treatment for this disease.

In addition, loved ones caring for those with dementia or professional caregivers will feel the emotional tolls and frustrations of managing care. The psychological toll is felt by everyone involved.

Without being “dementia-aware,” the impact of this disease on both the patient and caregiver is compounded. Dementia awareness allows us to appreciate the small, but meaningful moments and powerful connections between the patient and caregiver. The result is life-changing and can be life-saving.

There are still challenges, however. This is especially true when someone also has the symptom of anosognosia, which is a lack of insight that impairs the person’s ability to perceive the illness.

What this means is that someone who has dementia and expresses this symptom is unaware they he or she has dementia. This is caused when the brain no longer signals to the person that he or she is losing mental faculties — even as other dementia symptoms present themselves in their daily lives.

Many times, caregivers will encounter more difficulties and frustration because the “doctor knows best” approach is ineffective. Caregivers cannot expect gratitude, adherence or receptiveness. Instead, they will experience frustration, anger, overt or secretive non-adherence and suspiciousness.

Here are some ways to spot signs of anosognosia.

  • The person with dementia will no longer keep up with regular tasks or keep up with personal hygiene.
  • Difficulty managing money or bills.
  • Less inhibition in conversation or no filter.
  • Becoming angry when confronted about symptoms, increase confusion, lack of self-care, poor decision-making.
  • Confabulation: Making up answers with imaginary details.

In most of these cases, the patient will be persistent in their response, insisting that they did indeed take a shower, manage their bills or perform their tasks. When pressed, the person may become angry and defensive because they do not know that they do not know certain facts about their own behavior. These characteristics may be triggered at any time, even in a benign environment or circumstance.

Unfortunately, anosognosia simply means that a person’s brain is broken. Everyday situations are impossible to understand because the patient is entering the scenario with a fixed mentality — which may not provide the factual and contextual information he or she needs to carry on a conversation, interaction or a personal task. Therefore, proper care requires careful attention and training. We must think for our loved ones or patients to help minimize the effects of anosognosia.

Like I tell my clients: “Sometimes, the person who’s been there for everyone else needs someone to be there for them.”

These words are especially true when we care for patients with anosognosia.

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