Anosognosia and Dementia: Why my love-one may resist treatment
During a recent expressive art class for persons living with memory loss, the person was asked to draw a self-portrait. One gentleman drew an apple tree to the left of his paper with a dark blue cloud overhead. To the right of the tree was a man in a bright yellow shirt with a big smile (he was wearing a yellow shirt at the time). The man was holding one purple balloon and was drifting up toward a bright yellow sun in the sky. When I asked him to tell me about the picture, he replied, “I sometimes feel like I’m floating.” I wondered if he telling us he doesn’t feel grounded? Such a profound statement he was able to express through art.
Another man described his self-portrait and “drifting,” perhaps he felt he was”drifting” through the stages of dementia. Some people who live with cognitive decline, even in the later progression of memory loss, are aware of their lapses in memory, difficulty finding words, and the confusion. However many people with dementia or a mental health diagnosis do not recognize or have any awareness of their losses, troubling comments, or actions and may be experiencing anosognosia, a neurological condition where a person is unaware or denies significant neurological deficits.
This phenomenon is difficult for the person and their family member and friends. Since the person does not recognize that perhaps he/she is no longer safe to drive, cook, or handle their finances, trying to convince them only creates major conflicts. When someone does not know their limitations, reckless and dangerous behaviors can jeopardize the safety and well-being for the person and others. Anosognosia complicates the treatment approach and the person will need to rely on you or someone else for healthcare and medical decision making.
Anosognosia differs from denial, where the person may recognize the deficits but minimize the consequences. There is no specific treatment for anosognosia, but vestibular stimulation may temporarily improve the condition. Other treatments such as motivational interviewing, and cognitive behavioral therapy can help the person develop habits that can compensate for anosognosia, but it does not treat the condition itself. Creating and maintaining a trusting and meaningful relationship, and respecting the person’s belief, will minimize struggles and arguments.
If you would like more information about our Memory Ministry, our Monday morning Memory Cafe, or our Family and Friends Workshops please contact Vicky at vpitner@firstumc.org.