Practical resources to help family caregivers in the midst of caring for someone

Dementia and the loss of insight

The 7A’s tool was developed to help understand the way a person living with dementia is experiencing their world and how we can learn to support that person. Each of the 7A’s represents damage to a particular part of the brain associated with cognitive losses. It is worth noting that each of the “A” words are stand alone medical terms often relating to other brain disorders.

Here are the 7A’s:

  1. Anosognosia                          loss of insight
  2. Amnesia                                  loss of memory
  3. Aphasia                                   loss of language
  4. Agnosia                                   loss of recognition
  5. Apraxia                                   loss of purposeful movement
  6. Altered perception                loss of perceptual acuity
  7. Apathy                                     loss of initiation

Anosognosia (pronounced an-ah-sog-NO-ziah)

Anosognosia means the loss of ability to realize there is anything wrong. That is,  they don’t know that they don’t know. The person with dementia honestly does not realize there is a problem and is unable to understand or perceive the need for help. The lack of awareness can result in safety and behavioural issues and create challenges when the person resents suggestions of what or what not to do.

This is worth repeating because understanding this can help prevent conflict and arguments. The person with anosognosia is not pretending nor are they in denial. They live in the present moment but access their life from the past when they were well. This lack of insight occurs even when you show significant proof of a diagnosis or deficit. Here are some examples:

  • May blame others for mistakes, because they can’t see there’s anything wrong with themselves.
  • May continue to drive even if when evidence such as a formal letter is shown to them stating their driver’s license has been suspended.
  • May try to get up from a wheelchair to walk when not physically able.
  • Adult daughter believed her father was in complete denial about his illness and constantly reminded him of his diagnosis. He became frustrated and refused to take any memory medication because he did NOT have a problem. The daughter eventually came to understand that Dad was genuinely unaware that he had dementia and approached him differently.

Strategies for anosognosia

Try using LEAP model as an approach to anosognosia.

  • listen to the person
  • empathize with the person
  • agree with the person
  • partner with the person

Listen to what the person is trying to tell you and repeat their concern back to them using the same words. “I am really tired of people telling me what to do all the time.”

Your response: “Sounds like you’re really tired of people telling you what to do all the time.”

This will show the person you are listening.

Empathize with the person by validating their feelings. “I can see you’re really upset.”  When interacting, use positive words and a friendly and relaxed tone. This will demonstrate that you are supportive and understanding.

Agree with the person. Avoid arguing, insisting, reasoning or correcting the person. This is about connection not correction. If necessary, consider walking away to maintain your composure before reacting to the person’s behaviour. You can try talking to the person again later.  It would also be helpful to explain to other family or friends that the person’s behaviours are not willful or intentional and therefore, it is best to avoid confronting the person. Remind them to walk away and re-approach the person later.

Partner with the person on activities and tasks: “Let’s work together tidying up the kitchen, then we will have a cup of tea.”

Do you have an example of anosognosia? Tell us how you handled the situation.

 

 

 

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  • Eleanor Skelton
    Mon Sep 21 2020, 02:27
    Thank you for this info! My daughter has just been diagnosed with dementia. She is only 58 ! Covid - 19 is making this extra hard!
    • JaneVock
      Tue Sep 29 2020, 11:33
      Oh my gosh. That is very young to have a diagnosis of dementia. And for sure, COVID-19 will be making something already really hard, even harder. Please do take good care, Jane