Anosognosia: When You Don’t Realize You Are Ill
During Brain Injury Awareness month this March, we reflect on the devastating and long-term impacts of all kinds of brain injury, particularly dementia. Dementia is a common consequence of brain injury, but it differs from other types of dementia. For example, Alzheimer’s disease will get steadily worse over time; dementia following a head injury does not worsen over time, and may even somewhat improve slowly and gradually. Damage to the brain can cause people with Alzheimer’s, dementia and brain tumors to think there’s nothing wrong with them, says Daily Caring. The condition is called anosognosia. Those in hospice care in Alameda County and elsewhere may suffer from this affliction, causing additional strain among family members and caregivers.
A person with anosognosia doesn’t believe they have dementia, yet it’s different than denial and different than simply being difficult. A person who is in denial is aware of being ill yet they refuse to accept the fact. In the case of someone with anosognosia, the damage that dementia has caused in their brain means it impossible for them to be aware of what’s actually happening to them. In short, anosognosia is a condition that causes a person to be unaware of their mental health condition and how it is affecting them.
Therefore, a person who has been diagnosed with dementia, but who has anosognosia, does not know or even believe that they are suffering from dementia. Symptoms vary significantly by person to person, and they can change over time or even throughout the day. It doesn’t affect all seniors the same way every time, bringing good and bad days depending on medication, cognitive and overall health, and stress levels, according to Seniors Matter. The unawareness due to cognitive impairment can have a relationship to thinking skills, memory, emotions, or physical abilities. Those afflicted may have difficulty with language skills, such as finding the right words to use, often explaining such situations with excuses about being tired or forgetful.
If they forget to do basic tasks like bathe or miss appointments, they will likely insist they do not need help and that they’re perfectly capable of living on their own. If you remind them of the cognitive impairment they suffer from, don’t be surprised if they get angry and defensive. After all, they’re not convinced they have a problem. Being told otherwise can upset them even more.
Dementia and Head Injury
Dementia arising from a head injury is a big public health problem. Check out these stats from WebMD:
- Two out of 1,000 people in this country each year suffer from some kind of head injury, with many not seeking medical care.
- Up to 500,000 people are hospitalized for head injury every year.
- Younger people are more likely to suffer a head injury than older people.
- Head injury is the third most common cause of dementia in people under 50 years, after infection and alcoholism.
- Older people with a head injury are more likely to have complications like dementia.
- Men are more likely than women to suffer a head injury.
The vast majority of head injuries are caused by falls, followed by blunt trauma, motor vehicle accidents and assaults. Dementia-related symptoms after head injury include those affecting:
- Thinking and concentration
- Interactions with others
How to Help Someone with Anosognosia in Dementia
Here are some tips on how to handle a loved one with anosognosia.
1. Don’t keep trying to convince them they have dementia: While you may be tempted to use reason and evidence to explain their condition or insist they have dementia, this will only serve to upset them and make them more convinced that you’re wrong. Instead, discreetly make changes that help them live safely, remaining calm and focused on their feelings when you do express concerns. Make your comments as subtle and positive as you can.
2. Work with their doctors and caregivers: If your loved one’s dementia symptoms are getting worse and beginning to interfere with their daily lives, work with their care team and explain the problems your loved one is having. Together, you can creatively provide the patient with all the help they need without having to force them to admit the problem.
3. Pick your battles: Instead of correcting your loved one every time and having confrontations that are upsetting, choose your battles wisely, as stress only makes dementia symptoms worse. If something involves their safety, this is when you’ll have no choice but to assert yourself.
4. Present solutions subtly and positively: It’s helpful to be creative by offering solutions in a positive manner instead of talking about the problem. For instance, instead of saying “You can’t go outside alone because you’ll fall or get lost,” say “It’s such a nice day outside, so let’s go for a walk together to enjoy the fresh air.”