Anosognosia - pronounced uh-no-sog-NOH-zee-uh - is a big word that may have big meaning for caregivers who deal with seniors who have dementia or Alzheimer's . Many seniors experience a decline in mental faculties as they age. Some are diagnosed with mental illnesses long before they need senior-specific care. Declining health, loneliness, or boredom can cause depression, anxiety, or even suicidal thoughts in many older people. Seniors who experience symptoms of mental illnesses and are diagnosed by a physician may also appear to reject their diagnosis. A host of reasons can cause this reaction, and one of those is anosognosia. It literally means "to not know a disease," and it goes much deeper than simple denial.
Anosognosia is a complicated condition. Caused by a multitude of mental and cognitive illnesses, anosognosia occurs when a person cannot perceive their own illness. This could be because their illness disrupts their perception of reality, or because it diminishes their mental capacity. For example, it commonly affects people with bipolar disorder, schizophrenia, and dementia, since all of these disorders have the possibility of impacting the brain's cognitive processes, such as memory, sensory perception, and emotions. It goes beyond denial of symptoms; the brain of someone with anosognosia is incapable of recognizing their mental health as abnormal. Their brain cells actually show this change, which may appear on brain scans.
This condition does not affect all seniors the same way all the time. It may change over time, or have good and bad days depending on medication, overall health, cognitive health, stress, or other seemingly invisible factors. You cannot always predict what anosognosia will change about someone, even in one day. Just like dementia or depression, no two sets of conditions look alike, but frequently have certain symptoms in common. (This is discussed in the next section.)
Anosognosia is not when a non-physician, such as another caregiver or family member, suspects a senior of experiencing mental illness or cognitive decline and a senior denies it. A proper diagnosis comes from a trained medical professional. If you believe that a senior in your life might have a mental illness or be experiencing cognitive decline, discuss it with them and make an appointment with a psychiatrist or psychologist.
First and always, discuss this problem with other caregivers, including any doctors your senior sees. Working with a team is vital to caring for any senior, but seniors experiencing anosognosia require extra vigilance from caregivers. Because seniors with anosognosia do not understand their limitations, they may require more care than they will allow, or may not ask for care they need.
If you notice any of the symptoms of anosognosia in a senior for which you provide care (who has been diagnosed with a condition affecting their brain health), track any changes in their wellness. If you witness that senior denying they have trouble with memory, thinking skills like math or problem-solving, emotions, or body movement, despite a medical diagnosis, they may have anosognosia. (That list comes from a resource written by Dr. Leilani Doty, who specializes in cognitive and memory disorders at the University of Florida.)
Consistent, prompt, and accurate care regimens can help prevent seniors with anosognosia from overexerting or harming themselves. Some seniors who do not believe they are limited may try to drive, operate machinery, manage money, cook meals, or clean without necessary assistance, which puts their health in danger. Coordinating what tasks can and cannot be done and how to do them safely is vital to protect those with anosognosia. You may also have to make changes to thermostats, stoves, and item storage, just in case your senior cannot understand and pursues dangerous actions.
In addition to denying illness, seniors with anosognosia may become combative or frustrated, or even appear to lie, when faced with the reality of their condition. According to Dr. Doty, they may bring together stories, people, or events that do not belong together or experience anxiety. It is important to note that this grouping together of things is not a lie--it is called a confabulation. When a person's brain cannot make reality make sense, it will often cobble together things that do not exist or did not happen. (This can get worse under stress.) Discussing this with a calm demeanor and picking your battles can help to avoid conflict.
In general, when you deal with anosognosia, opt for a positive expression of solutions rather than listing problems. For example, say to your senior, "It's a beautiful day outside. Let's go for a walk together and talk about trips we've taken abroad," rather than, "Time for a walk. You can't go alone, so I will be holding your hand or arm while we walk so you don't wander." Make compromises that ensure safety, again with a positive twist: "How about I help you tidy the house up before we watch that movie you like?" The less a person feels limited for reasons they cannot understand, the less likely they are to become anxious, angry, or confused as a result of their treatment. Reminding them about medicines, for example, can be done strictly but positively: "Time for your medications! Remember that you need your brain health meds, just like your heart health meds."
As with all things caregiving, you will experience ups and downs of caring for seniors with anosognosia. Keeping up to date on the symptoms and causes, working with your team, and staying positive in the face of resistance go a long way toward keeping them healthy, safe, and happy.
Anosognosia.org. What is Anosognosia? Available at http://www.anosognosia.org/. Retrieved April 4, 2017.
Doty, Leilani. Anosognosia (Unawareness of Decline or Difficulties). AlzOnline.net/University of Florida. Available at http://alzonline.phhp.ufl.edu/en/reading/Anosognosia.pdf. Retrieved April 4, 2017.
National Alliances on Mental Illness (NAMI). Anosognosia. NAMI.org. Available at https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Anosognosia. Retrieved April 4, 2017.