Anosognosia is not simply denial. It is a complex condition that impairs one’s ability to perceive themselves as ill. It often affects dementia patients, and it comes and goes. An affected person may clearly understand that they have dementia one moment and then show complete lack of awareness of their disease in another. This fluctuation may make you think your elderly loved one is simply in denial about their cognitive impairment. However, people who have anosognosia are truly unaware that they have a cognitive condition that requires treatment.

Key Takeaways

Anosognosia is much more than denial. It’s the inability to identify the presence, progression, and limiting effects of a disease.
Anosognosia is common among people with Alzheimer’s and other forms of dementia. Symptoms of anosognosia may worsen as dementia progresses.
Use the LEAP method when caring for a loved one with anosognosia. This evidence-based approach is one of the best ways to communicate with a loved one.
Talk to an expert. If it’s become difficult for your loved one to remain at home due to worsening dementia, consider in-home care services or memory care communities.

What is anosognosia?

Anosognosia (pronounced uh-no-sog-NOH-zee-uh) ^[01] is a medical condition often defined as a lack of insight. Anosognosia is the inability to identify the presence of a disease, as well as its progression and how it limits life, according to the journal Neurologia.

Understanding anosognosia and how it affects those with Alzheimer’s disease or other forms of dementia can help you empathize with your senior loved one. It can also help you plan the best care for your loved one and find strategies to help them get the treatment they need.

If your loved one has anosognosia, they may be unaware that they have a cognitive impairment. They may hide their dementia symptoms or give excuses for concerns you bring up with them. They may also refuse treatment.

However, anosognosia symptoms may come and go. Your loved one may sometimes be agreeable and comply with treatment. Other times, they may completely forget they’re ill. In some cases, a person with anosognosia may be aware of some symptoms of their illness and unaware of others.

Without treatment, symptoms of anosognosia may worsen and hinder your loved one’s ability to perceive their underlying illness. It may be difficult for caregivers and family members to help a loved one with anosognosia get treatment for their cognitive illness.

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Anosognosia: Causes, diagnosis, and treatment

Caregivers often have difficulty differentiating anosognosia from denial. This is because anosognosia can affect people differently, and the degree of a patient’s awareness may fluctuate.

Causes

Anosognosia is difficult to fully understand. Certain neurological and mental health conditions can affect the brain’s frontal lobe, and the frontal lobe controls memory and a person’s perception of themselves, including their perception of their health.

Throughout life, people constantly update how they think of themselves based on different life events, such as marriage, a graduation, or an injury. In people with anosognosia, the frontal lobe doesn’t work as it should. This means the person can’t update their perception to understand changes in themselves or their illness.

Diagnosis

If your parent or loved one has a condition associated with anosognosia, their doctor may use assessment tools to diagnose it. These assessments can check if your loved one can recognize the following:

Whether they have symptoms of a condition
The social consequences of their symptoms
That they need treatment for their condition
That their symptoms may result from a health condition

Treatment

It’s not easy to treat anosognosia. Treatment is based on the condition that’s causing it. For people who are diagnosed with Alzheimer’s disease but are unaware of their condition, it may help to seek care from a specialized dementia counselor.

Certain types of therapy, such as motivational enhancement therapy (MET), can help someone take a closer look at their symptoms and behaviors. Behavioral therapies like MET may lead to improved awareness. Rather than convincing people with anosognosia of their illness, this type of talk therapy helps them understand the benefits of changing their behavior and how to develop goals for improved health and quality of life.

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Who is typically affected by anosognosia?

Anosognosia is most commonly associated with schizophrenia and bipolar disorder. However, symptoms of anosognosia are also linked to dementia and these specific conditions:

Depression
Traumatic brain injury
Stroke
Brain tumors
Huntington’s disease

Anosognosia is also fairly common in people with Alzheimer’s disease. It’s estimated that up to 81% of people with Alzheimer’s ^[02] have some form of anosognosia. According to research, symptoms of anosognosia may also worsen as Alzheimer’s disease progresses. ^[03]

How do you help someone with anosognosia?

For many dementia caregivers, the symptoms of anosognosia can sometimes be more frustrating than those of dementia itself. You may feel frustrated and helpless if you’re caring for a parent with Alzheimer’s who doesn’t know they have it. However, understanding how to care for someone with anosognosia is crucial for dementia caregivers.

A great way to help a loved one who has anosognosia is to use the LEAP method ^[04]:

Listen. Let your loved one know that you hear what they’re saying. Reflect back what they said without changing or influencing the meaning of their words.
Empathize. Identify with your loved one’s experience to help them feel understood and respected. This might help them feel less defensive and more open to listening to your opinion.
Agree. Find something you can agree with them on, and focus on it. Avoid offering your opinion until they ask for it.
Partner. Build trust with your loved one to increase cooperation. You may not agree on the problem, but you can work together to find a solution — because your relationship matters more than logic.

If you notice symptoms of anosognosia, make an appointment for your loved one to see their doctor or therapist for an assessment. A medical professional can recommend treatment and strategies to help ensure your relative gets the help they need. A doctor’s or therapist’s visit can also sometimes help relieve your stress and heartache as a caregiver.

Next steps

As Alzheimer’s disease or another dementia progresses, it’s important to prepare for future care needs.

Consider contacting a Senior Care Advisor for free, expert advice about senior care options in your area, including in-home care services and memory care communities.

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References

National Alliance of Mental Illness (NAMI). Anosognosia.
Acharya, A. B., & Sánchez-Manso, J. C. Anosognosia. StatPearls Publishing.
Castrillo Sanz, A., Andrés Calvo, M., Repiso Gento, I., Izquierdo Delgado, E., Gutierrez Ríos, R., Rodríguez Herrero, R., Rodríguez Sanz, F., & Tola-Arribas, M. A. (2016, June). Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression. Neurologia.
Henry Amador Center on Anosognosia. About LEAP.

Meet the Author

Grace Styron

Grace Styron is a writer at OurParents specializing in assistive technology, memory care, and home care. Before writing about healthy aging, she worked for an online women’s lifestyle magazine and as a grant writer for a nonprofit regenerative permaculture farm in Virginia. She earned her bachelor’s degree from Missouri State University.

Edited byMarlena Gates

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

Anosognosia and Dementia: More Than Denial