Family caregivers often ask, “how do you tell someone they have dementia?” And in some cases, the answer may be that you simply can’t. Damage in the brain can cause people with Alzheimer’s disease, dementia, stroke, brain tumors, and other cognitive impairments to believe that there’s nothing wrong with them. When that happens, it’s called anosognosia. The word literally means “to not know a disease” and it’s much more than being in denial.Anosognosia is a condition that causes someone to be unaware of their mental health conditions and how it affects them. It’s common in some conditions, including dementia. So, someone who has been properly diagnosed with dementia, but has anosognosia, doesn’t know or believe that they have dementia. However, anosognosia symptoms may vary significantly from person to person, change over time, and might even fluctuate within a day. The person might sometimes understand what’s happening and other times firmly believe that they are completely fine. And depending on their level of self-awareness, other people might only be partially aware that there’s something wrong. The unawareness of cognitive impairment can be related to memory, general thinking skills, emotions, or physical abilities. They might have occasional difficulty with language skill, like finding words, but they can explain away these situations with excuses about forgetfulness or fatigue. And even if they forget to bathe, miss appointments, or burn food on the stove, they’re still likely to insist that they don’t need help. They’ll probably also insist that they’re absolutely capable of living independently despite clear evidence that things are going wrong. If someone reminds them of their cognitive impairment, someone with anosognosia may get angry and defensive because in their mind they’re 100% convinced that there is no problem.Anosognosia in dementia isn’t the same as denial. It’s important to understand that someone who has anosognosia in dementia isn’t just being difficult or in denial – this is something different. When someone is in denial, they are aware of a fact, but refuse to accept it. With Anosognosia, the damage that dementia is causing in their brain makes it impossible for that person to be aware of what’s happening to them.Don’t try to convince them they have dementia. Using reason and evidence to explain or insist that someone has dementia is not going to help. It will only upset them and will likely make them even more convinced that they are right, and ...
