What You Should Know About Anosognosia When Caring For A Loved One

There are a lot of phrases that caregivers and loved ones in Maquoketa and elsewhere don’t always like hearing, and “I’m fine” is pretty high on the list.

This goes for people receiving hospice care, battling dementia, recovering from a stroke or dealing with other serious health conditions which likely shouldn’t make someone feel “fine” at all.

The team at Above and Beyond Home Health Care hears this response quite a bit from patients but has learned strategies to, in effective ways, learn more details about how a patient is truly feeling.

Maybe they actually are fine, considering their current circumstances and condition, and try to put things in perspective and look for the bright side of things.

Some may say “I’m fine” as a way of saying “Don’t worry about me, I’m OK” even if their brain or body hurts or they’re feeling unhappy and unpleasant. People who say this may not want to burden others with their sad situations or want any special attention. There could be a bit of denial, as they try to smile or be stoic through whatever pain they’re going through.

But as a practitioner or home health care specialist likely will tell them, “We can’t help you if you don’t honestly tell us how you’re feeling” and then encourage them to give more details about their situation or condition.

It’s not denial

The third type is the most tricky: it goes by the scientific term of anosognosia. It’s a mental disorder where someone truly believes they are in great shape even though their bodies or health conditions tell another story.

This can be seen when people have strokes that disable or limit the range of motion in part of their body. But their damaged brain may still receive signals that everything is working fine, so they’ll believe it.

This is also shown in some mental or physical conditions where people decide to stop taking their medications because they feel good, not because the medication helped create this feeling. Withdrawing medication at a crucial time can often cause a wide variety of problems or at least a cycle of feeling good and feeling bad.

Anosognosia isn’t denial, which is a psychological situation where someone is aware of something that isn’t correct but consciously or stubbornly chooses not to believe it. With anosognosia, their brain tells them that things are good, in spite of health care providers, family members, caregivers and sometimes their own bodies that may indicate otherwise.

WebMD reports at least 50 percent of people with schizophrenia may have anosognosia, as well as 40 percent of those with bipolar disorders. People with these types of mental conditions may simply believe their reality is correct and don’t think they need to alter it with medication.

The condition is also seen in people with strokes or dementia since both conditions involve physical changes to the brain, sometimes permanent.

Mental health experts believe there may be a biological cause: a part of the frontal lobe that controls our perception of the world may be impacted and not work like it’s supposed to. This area is known to provide a regular reflection of ourselves, including our self-image.

When our brains work as they’re supposed to, we’re always receiving fresh updates about ourselves, everything from physical changes like a haircut to a sunburn.

But with trauma from disease, dementia or illness, we may not get this self-image updated as often or it may not be complete or thorough. It may present information about how we used to be prior to the current condition.

How to help

Trying to assist someone when they don’t know or don’t believe they need help isn’t easy, especially in dementia situations.

The National Association for Mental Illness said people with anosognosia may vary in their awareness of it. Like dementias, there may be days or hours when they know something isn’t working, and there may be times when they feel great.

People with dementia may find ways to blame the symptoms on other causes, such as being tired, feeling ill or just a little forgetful.

Daily Caring suggests that there are things loved ones and caregivers can do and things they shouldn’t do.

• Avoid facts. If their brains tell them they’re feeling great, they may instinctively doubt someone who says something else and wonder why there’s confusion. Since suspicion is already a common symptom for people with dementia, being told conflicting stories can be confusing and frustrating to them.
• Be subtle. If they feel like going for a walk, don’t stop them or warn them. Instead, join them and find a way to make the experience positive for you and for them. If you need them to take their medication and vitamins and they don’t see the need, find another way, such as having the whole family take vitamins together. Encourage them to keep doing the things they can and find ways to keep them away from unsafe tasks.
• Talk to their medical team. Providers, nurses, or home health care specialists like the team at Above and Beyond may have advanced training in these types of situations and can offer coping suggestions for caregivers, family members and loved ones without upsetting them.

Overall,  people with loved ones with anosognosia and dementia still may find ways to enjoy the experience as much as possible.