Is It Really Denial? Anosognosia vs. Denial in Dementia

In today's blog I wanted to briefly talk about something called anosognosia. A lot of people aren't really familiar with this term or what it means, which is exactly why we wanted to make this blog. So, what is anosognosia and why is it so important when it comes to dementia care? Let's break it down.  

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Anosognosia is actually derived from Greek words. So "A" = without, "Nosos" =  Disease, "Gnosis" = knowledge. So when directly translated, anosognosia means to be without disease knowledge. What this is, is really a deficit of self awareness. It's this lack of self awareness, especially when it comes to being aware of having a certain condition or disease. Now, on this blog, we focus on dementia, but I want you to know that anosognosia is common in strokes, traumatic brain injuries and even mental health conditions like schizophrenia and bipolar disorder.

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Anosognosia is actually associated with right hemisphere brain damage, including parts of the frontal lobe, the parietal lobe, the temporal lobes and even parts of the basal ganglia or thalamus. So, it's damage to the brain that causes a person to believe that they're completely fine or to at least be unable to recognize the extent of their impairment. So what happens when they are confronted with the reality of their impairment or their condition or their deficits is that they might appear to lie, they might get angry or frustrated, or they might come off as defensive. Right? But it's not that they're in denial. It's that they are unable to recognize these deficits. So, if you're approaching them saying that, "Oh, you did this." "Oh, you did that." "You can't do this." "You can't do that." They're going to think, "I'm fine, so it must be you that is lying." "It must be you saying these nasty things about me and making things up." Right? So that is why it might appear like the person is in denial, because to you, it's clear as day that they're doing all of these things, but they are sitting here denying or coming off as lying or getting angry at you about something you clearly saw them do. To them, there is no issue. This can be really dangerous, especially when it comes to things like driving or cooking, because they can be super unsafe, but not recognize that there are those safety impairments.  

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Now, the tricky part about anosognosia is that their level of awareness can actually fluctuate. It can fluctuate within a day. It can fluctuate from day to day, and it can change over time. But this is the brain that we're talking about, so that really shouldn't come to us as a surprise. Right?

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So, how does anosognosia differ from true denial? So with denial, it is actually a psychological defense mechanism. Denial is when you are completely aware of the truth, of the facts, of the reality, but for whatever reason, you just refuse to accept it. Ok? So you're aware, but you refuse to accept it. With anosognosia, on the other hand, there is damage to the brain that is causing the person to be unaware of their deficit. They lack insight into their deficits. Ok? This is why you never want to try to convince your partner that they have dementia or that they have X, Y, Z impairment. You don't want to go listing off all the things that they can't do to try to prove a point because it won't work. All you'll end up doing is either pissing them off or upsetting them. So, it's really just pointless. Ok?  

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