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  • Writer's pictureTroyer & Good, PC

Anosognosia and Alzheimer's

More than 5 million Americans are living with Alzheimer's. Over 80% of those do not even know they are ill - they have anosognosia. Anosognosia is not being in denial about your illness. Rather, it is a lack of awareness of your impairment.

A famous example is that of President Woodrow Wilson. After his stroke, his mental health suffered and his personality began to change. He became suspicious and paranoid but had no idea he had changed.

Anosognosia is being unaware of your illness, not denial

Anosognosia is very common. One study notes that up to 77% of patients who had a stroke displayed signs of anosognosia at least temporarily. It often occurs in people with mental illness, a traumatic brain injury, and Alzheimer's or other dementias. It can be very difficult for family members to help their loved one when he is not aware he is ill.

Anosognosia results from physical changes or damage (like from a stroke or dementia) to the part of your brain that affects your perception of your illness. It has long been common in people with Alzheimer's, brain tumors, Huntington's disease, and stroke. It is estimated that some 81% of people with Alzheimer's disease have some form of anosognosia, according to AlzOnline.

Someone with anosognosia may need help with routine tasks but insist they do not need help. They might refuse medical evaluation or treatment, which can be challenging for caregivers. Anosognosia is difficult to diagnose because it may be complete or selective. For example, they may be totally unaware of their impairment or they may react with anger if confronted about their illness.

A Place for Mom lists these signs to look for if you are worried that your loved one may have dementia with anosognosia:

  • Not keeping up with regular daily tasks or personal hygiene

  • Difficulty managing money or bills

  • Being more spontaneous or less inhibited in conversation without concern for their own behavior

  • Becoming angry when confronted with forgetfulness, lack of self-care, or poor decision making

  • Confabulation: making up answers they believe are true, though sometimes the details may be imaginary, may pertain to something that happened in the past, or even something they read or heard elsewhere

If you believe your loved one has Alzheimer's or dementia with anosognosia, be patient. Instead of trying to make the person understand, which often only results in frustration, try to communicate positively and stay calm. Create a schedule of tasks and personal care for your loved one when a caregiver is available to help. Use outside aid to take over certain responsibilities (like cleaning or money management) for your loved one. Or you can work together with your loved one to tackle those responsibilities. These suggestions can help you deal positively with your loved one who may not know he is ill.

Anosognosia highlights the importance of having a financial Power of Attorney and Advance Directives for Health Care in place before you become ill. These documents name someone you trust to take care of your financial and medical decisions when you are no longer able to do so yourself. Our skilled attorneys can help you create an estate plan that prepares you for the future.


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