Those diagnosed with Alzheimer's dementia often show a lack of consciousness and deny or maintain that there is nothing wrong with them.
This of course is incredibly difficult and as with most facets of dementia - our patience as a carer of our loved one is severely tested at times.
What is Anosognosia?
Anosognosia - is from the Greek - meaning “lack of awareness or insight”
Anosognosia is the inability or refusal to recognize a disorder (such as dementia) that is evident.
The part of the brain that does “self-monitoring” (i.e. the part that monitors tasks that we find easy and tasks that we find more difficult)
- doesn’t update.
This means that the brain will “default” to old information.(e.g. “of course I don’t have any problems with my memory”). So if someone doesn’t think that they have a problem, then they will not see that there is a need for help, they will not ask for help and will see help or support as unnecessary, interfering and possibly patronising.
This can lead to Confabulation - (Making up answers with imaginary details). (i.e. people make justifications and tend to externalise the problems (e.g. “ if you had told me sooner, then I wouldn’t have forgotten”).
People do not always feel comfortable admitting to themselves or others that they have a disorder they have been newly diagnosed with. This is not abnormal and most people ultimately accept the diagnosis. But occasionally, the rejection is long-lasting. It is not simply denial that is making a person reject the facts. It is a disorder called anosognosia.
This is a lack of ability to perceive the realities of one’s own disorder. It is a person’s inability to accept that they have a disorder that matches up with their symptoms or a formal diagnosis. This happens in spite of significant evidence of a diagnosis.
Anosognosia is an effect of alterations to the brain. It is not just obstinacy or total denial, which is a defence mechanism some people use when they acquire a difficult diagnosis to cope with.
Anosognosia develops from the physiological damage to brain structures, normally to the parietal lobe or a diffuse lesion on the fronto-temporal-parietal region in the right hemisphere - It is thus a neuropsychiatric disorder.
The perception of a person changes throughout their life. A person who just got married may feel reassured now that he or she has finally tied the knot with someone he or she loves. When a person has a new scar on the face, his or her brain needs to take it into account so that they remember it is there when they look in the mirror. The frontal lobe is heavily affected in this continual process of reshaping the self-image.
This produces frontal lobe tissue remodeling over time and ultimately, the person may lose the ability to take in new information and renew the perception of their overall health. Since the brain cannot grasp the newer information resulting from the disorder, the loved one or carer can become very frustrated that the person appears not to be taking the disorder seriously.
Those diagnosed with Alzheimer's disease often show this lack of consciousness and maintain that there is nothing wrong with them.
Anosognosia may happen as a component of receptive aphasia, a language disorder that induces poor comprehension of speech and the formation of fluent but not comprehensible sentences. A patient with receptive aphasia cannot improve his own phonetics errors and shows anger with the person with whom he or she is speaking because that person fails to understand him or her.
The person with anosognosia may no longer keep up with regular tasks or keep up with personal hygiene. They may have a persistent lack of insight and a false belief of not been sick even when confronted about symptoms or medical evidence, leading to a strong denial of any need for medical treatment.
When pressurized, the person may become angry and defensive since they do not know that they do not know certain facts about their own behaviour.
Support for a person with anosognosia :
This of course is incredibly difficult and with most facets of dementia - our patience as a carer of our loved one is severely tested at times.
Somebody with anosognosia may not take their medication.
Why would the person take a medicine (particularly one that might have unpleasant side effects) if that person does not believe that there is anything wrong with him or her?
Do not judge - This is a medical disorder, not stubbornness or self-destructive disorders.
Be supportive - People may have better days than others. Even if someone entirely loses their perception of their disorder, they are not doing it on purpose.
Keep notes - Maintaining a detailed diary of what the person says and does can help the person get evidence of the disorder. This can not only help some people realize that they have anosognosia, but also supply the doctor with a stronger basis for a treatment plan.
It is estimated that 60% of patients with mild cognitive impairment and 80% of patients with Alzheimer’s disease seem to have some form of anosognosia.