Alzheimer's / Dementia

9/21/2021 | By Seniors Guide Staff

There are, of course, many facets to dementia other than just memory loss. One common coupling is anosognosia and Alzheimer’s disease; we look at what this means, its symptoms, and how to understand it.

When someone refuses to believe a mental illness diagnosis, others will explain it away as the person being “in denial.” However, anyone who has acute mental illness might not have the ability to choose denial knowingly. Instead, they could be experiencing a symptom of mental illness impairing their ability to perceive the disease. The condition is known as anosognosia, and it roughly translates into “lack of insight” or “lack of awareness.”

Anosognosia is a symptom of specific mental illnesses, including Alzheimer’s disease and dementia, and is one of the most difficult to recognize for anyone who has never faced it. Because around 50% of individuals with schizophrenia and 40% with bipolar disorder develop symptoms of anosognosia, studies of the psychiatric disorder result in a body of evidence indicating there is anatomical damage in the part of the brain involved with self-reflection.

What causes anosognosia?

Anosognosia stems from physiological damage to the brain’s frontal lobe, the area that is involved in self-reflection. For example, when people learn a new skill, they adjust their self-image to be more competent. However, this complicated process requires the brain’s frontal lobe to organize further information, create a revised narrative, and remember the new self-image.

Using brain imaging, researchers now understand that mental disorders such as schizophrenia, bipolar disorder, and dementia may damage this critical area of the brain. When the frontal lobe isn’t operating correctly, a person could lose the ability to update their self-image. And without an update, they hold on to the self-image they had before the illness.

Because these former perceptions feel accurate, they assume others are mistaken or lying to them. People with anosognosia and Alzheimer’s (or any disease) often become frustrated when their loved ones insist there is something wrong with them. They may even avoid their loved ones while refusing medications or treatment.

How is anosognosia diagnosed?

Doctors sometimes recommend seeing a mental health professional if a loved one has been diagnosed with a condition associated with anosognosia. The specialist can then observe their overall mental health and any accompanying symptoms. The specialist might also recognize anosognosia immediately, even with only slight behavior changes.

One common technique is the “LEAP” method. It consists of:

Listening to the person

Empathizing with them

Agreeing with the person

Partnering with them

Using LEAP allows for a dialogue between a doctor and the person with anosognosia while enabling them to begin an awareness of their situation. It also helps them realize that those around them are caring and supportive.

Another popular diagnostic tool is the Scale to Assess Unawareness of Mental Disorder (SUM-D). This rather lengthy anosognosia test puts the idea of “insight” on a spectrum that includes:

  • Awareness: Does the person understand that they have a condition? Do they notice the symptoms of the condition? Do they realize there may be social consequences of their condition?
  • Understanding: Does the person recognize the need for treatment?
  • Attribution: Do they believe their symptoms come from a mental health condition?

The person’s SUM-D test results could indicate if they have anosognosia.

Why is it so important to understand and diagnose anosognosia and Alzheimer’s?

It can be dangerous for someone with a serious mental illness to insist they aren’t sick or perhaps not as ill as others tell them they are. People with anosognosia are not likely to take their medication. After all, why take a drug with nasty side effects when you don’t believe there’s anything wrong with you?

And when they stop taking the meds, the symptoms typically return, often worse than before. They could start hearing voices, acting recklessly, or become a danger to themselves. Many of them become homeless or end up getting arrested.

While no medications currently exist to relieve anosognosia, some recent findings do offer hope for future treatments.

Seniors Guide Staff

Seniors Guide has been addressing traditional topics and upcoming trends in the senior living industry since 1999. We strive to educate seniors and their loved ones in an approachable manner, and aim to provide them with the right information to make the best decisions possible.

Seniors Guide Staff