A man with Alzheimer’s looking at an image of him cooking for himself. His back is turned on the reality where he is being served by a caretaker.

Beyond Denial: Anosognosia & Alzheimer's Disease

"The doctors do not know what they are talking about. I don’t have Alzheimer’s disease!"

This is probably sounding familiar to some of your reading this right now. A lot of our loved ones with Alzheimer’s disease might say this often. It has to be that our loved ones are in denial. However, what if I told you that it might be more than denial. More than denial?

What is anosognosia?

One study in the Journal of Neurology, Neurosurgery & Psychiatry defines anosognosia as the "inability to identify the presence of the deficits or characteristics of a disease, as well as their magnitude, progression and how they limit life."1 Anosognosia is pronounced uh-no-sog-NOH-zee-uh.

In people with Alzheimer's, “anosognosia was construed as the denial or lack of awareness of impairments in activities of daily living (ADL) or about neuropsychological deficits."1 The study reports that anosognosia is very common in people with Alzheimer’s disease. Researchers estimate that 81 percent of people with Alzheimer’s have some form of anosognosia.

Why does anosognosia happen?

Experts in the field of Alzheimer’s believe anosognosia occurs when the frontal lobe of an individual deteriorates or becomes damaged. The frontal lobe of our brain is in charge of our ability to think abstractly, perceive, problem-solve, and socialize. So when this becomes damaged the individual will have issues in the above-mentioned skills.

Is it denial or anosognosia?

The lack of awareness associated with anosognosia is very different from the initial shock and denial, one feels from initial diagnosis. Changes in a person’s brain with Alzheimer’s disease and other forms of dementia are left to believe that they are perfectly healthy. A person can experience selective or complete lack of awareness. Your loved one’s physician can run very specific tests to help come to a diagnosis of anosognosia.

5 signs your loved one has dementia with anosognosia:

  1. Unable to maintain normal everyday tasks and/or personal hygiene.
  2. Showing less inhibition and increased spontaneity in conversations, without realizing or being concerned about their behavior.
  3. Uncharacteristic or decreased ability to manage their money or monthly bills.
  4. Will make up answers to things. However, they believe that what they are saying is true.
  5. Exhibits poor decision making, decreased self-care, and quick to anger when their forgetfulness is brought up.

Anosognosia and caregiving

Anosognosia can provide challenging in those individuals with Alzheimer’s disease and various other forms of dementia. Our loved ones can be completely convinced they are healthy. To the point where they may refuse medications, treatments, and any medical evaluations. This can lead to extreme frustration with caretakers.

Below are 5 tips to help caregivers to relate better with their loved one with Alzheimer’s disease and anosognosia.

  1. Provide structure and schedule of daily tasks.
  2. Work together with your loved one with money management and cleaning tasks.
  3. Remain focused and calm when speaking with your loved one when voicing any concerns, you have.
  4. Focus activities and appointments in the morning hours, when your loved one is more rested.
  5. As always be gentle, empathetic, and encouraging with your loved one.

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