Anosognosia: When Dementia Patients Can’t Recognize Their Impairment


Are dementia patients aware of their condition?

Family caregivers often ponder this question as their loved ones begin experiencing telltale symptoms: memory problems, confusion, and behavior changes. In a similar vein, they often seek advice on the AgingCare Caregiver Forum as to why an aging parent or spouse is adamantly refusing care they clearly need.

Many seniors who’ve been diagnosed with Alzheimer’s disease or other forms of dementia refuse to stop driving, won’t accept in-home care, and resist the idea of moving to senior living. This could be because they’re wholly unaware of their impairment. If your loved one doesn’t seem to acknowledge their diagnosis, anosognosia may be to blame.

Anosognosia is not denial of dementia

The term anosognosia is Greek in origin and means “without knowledge of disease.” Anosognosia can affect people with Alzheimer’s disease or other types of dementia, mental illness, traumatic brain injury, brain tumors, and stroke. Changes in the brain are what cause a person to truly believe there’s nothing wrong with them.

This is why anosognosia differs from the initial shock and denial that many individuals and families experience following a dementia diagnosis.

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Anosognosia in dementia patients

Studies estimate that 60% of patients with mild cognitive impairment (MCI) and 81% 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. It can also pertain to their memory, general thinking skills, emotions, and physical abilities.

The ways in which those with anosognosia react to mentions of their deficiencies vary as well. For example, a dementia patient may experience difficulty with language skills, like finding the right words when speaking. They may rationalize or explain away these situations with a general excuse about age-related forgetfulness or fatigue.

Seniors with anosognosia may also have short-term memory problems. This can cause them to forget to bathe, miss appointments, or leave food to burn on the stove. Someone who has anosognosia will still insist that they’re capable of performing daily activities on their own, despite clear evidence of their impairment.

Some may even become angry when confronted about their mental deficit because they’re convinced it doesn’t exist.

Caring for a dementia patient with anosognosia

For dementia caregivers, anosognosia can sometimes be more frustrating to deal with than a loved one’s actual lapses in memory.

You witness their abilities changing before your eyes. But how can you convince them that they’re no longer able to safely drive, cook, or handle their finances when they don’t even understand they’re ill?

As with most dementia behaviors, learning more about anosognosia in dementia patients 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.” — caring4alice

Some patients are completely convinced they’re still healthy and competent. They may even refuse to go to doctor’s appointments, undergo neurological testing, receive medical treatments, or take medications.

We’re all familiar with the adage, “You can’t help those who won’t help themselves.” With dementia, even when someone doesn’t acknowledge the disease or want assistance, intervention of some kind is usually necessary.

Coping with anosognosia

Not only is anosognosia difficult for your loved one, but it can also create tension in your relationship with them.

The LEAP method can help you better communicate with your loved one. It stands for listen, empathize, agree, and partner. Rather than trying to convince your loved one they’re sick, actively listening to their point of view can help build trust and respect.

“If we are to increase understanding and reduce uncertainty experienced by people with dementia, we must fully sink ourselves into dealing with and truly understanding what is experienced and take a more thoughtful approach to their condition.” — GeriCareFinder

Being supportive may help encourage your loved one to be more open and honest about their perspective.

The information contained in this article is for informational purposes only and is not intended to constitute medical advice or diagnosis. Always seek the advice of your physician or other qualified health care provider regarding any medical condition or treatment, and never disregard professional medical advice or delay treatment based on anything you have read on this site. Links to third-party websites are only for the convenience of the reader; AgingCare does not endorse the contents of the third-party sites.

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