Family caregivers often ask, “how do you tell someone they have dementia?”

And in some cases, the answer may be that you simply can’t.

Damage in the brain can cause people with Alzheimer’s disease, dementia, stroke, brain tumors, and other cognitive impairments to believe that there’s nothing wrong with them.

When that happens, it’s called anosognosia.

The word literally means “to not know a disease” and it’s much more than being in denial.

Anosognosia is a condition that causes someone to be unaware of their mental health conditions and how it affects them. It’s common in some conditions, including dementia.

So, someone who has been properly diagnosed with dementia, but has anosognosia, doesn’t know or believe that they have dementia.

However, anosognosia symptoms may vary signifi cantly from person to person, change over time, and might even fluctuate within a day.

The person might sometimes understand what’s happening and other times firmly believe that they are completely fine.

And depending on their level of self-awareness, other people might only be partially aware that there’s something wrong.

The unawareness of cognitive impairment can be related to memory, general thinking skills, emotions, or physical abilities.

They might have occasional difficulty with language skill, like finding words, but they can explain away these situations with excuses about forgetfulness or fatigue.

And even if they forget to bathe, miss appointments, or burn food on the stove, they’re still likely to insist that they don’t need help.

They’ll probably also insist that they’re absolutely capable of living independently despite clear evidence that things are going wrong.

If someone reminds them of their cognitive impairment, someone with anosognosia may get angry and defensive because in their mind they’re 100% convinced that there is no problem.

Anosognosia in dementia isn’t the same as denial.

It’s important to understand that someone who has anosognosia in dementia isn’t just being difficult or in denial – this is something different.

When someone is in denial, they are aware of a fact, but refuse to accept it.

With Anosognosia, the damage that dementia is causing in their brain makes it impossible for that person to be aware of what’s happening to them.

• Don’t try to convince them they have dementia.

Using reason and evidence to explain or insist that someone has dementia is not going to help. It will only upset them and will likely make them even more convinced that they are right, and you are wrongly discrediting them. A more effective strategy is to discreetly make changes that will help them live safely. And overall, stay calm and focused on their feelings when expressing your concerns and keep your comments as subtle and positive as possible.

• Work with their doctors and care team. When your loved one’s dementia symptoms are interfering with their daily lives, it’s time to start working with their care team – including doctors, relatives, friends, in-home caregivers, or assisted living staff.

• Explain the problems your loved one is having and help the team understand that they aren’t aware of their dementia and why it won’t help to try to convince them logically. Work together to creatively provide your loved one the support they need with the activities of daily living without waiting for them to ask for help or forcing them to admit there is a problem.

• Discreetly make their life as safe as possible.

Making your loved one’s everyday life simpler and safer can help prevent someone with anosognosia in dementia from hurting themselves or others. Some people might try to drive, manage money, cook, or do other activities that could be dangerous because of their cognitive impairment. Without mentioning dementia as the reason, you may need to make changes like finding creative ways to stop them from driving, working together so you can prevent problems with fi nances, making the kitchen safer, or making the home safer overall. Use positive approaches and present it as removing burdens from their life so they can do more of what they enjoy rather than doing chores. • Avoid correcting them and having confrontations, pick your battles. When someone has dementia, their brain may experience a different version of reality because of the damage the disease has caused. Dementia care experts recommend stepping into their reality rather than trying to correct them. Their brain is losing the ability to process information and forcing them to join the “real world” only causes confusion, anxiety, fear, and anger. If something is a serious safety issue, you may have no choice but to insist on doing things your way.

• Present solutions positively and subtly. The less your loved one feels that they are being limited for reasons they don’t understand, the less likely they are to become angry or resist help. Generally, when someone has anosognosia, it helps to be creative and offer solutions in a positive way rather than talking about the problem. For example, you might say, “It’s a beautiful day outside, Let’s go for a walk together so we can both enjoy the fresh air.” That’s positive and much easier the accept that in you had said “You know you can’t go outside alone, you’ll fall or get lost, I have to go with you.”

• Learn more about dementia and dementia care techniques. Many of the most effective dementia care and communication techniques aren’t easily figured out and might even be the opposite of your instincts. Not knowing these helpful techniques can cause added frustration and stress for both you and your loved one.

If you are a family caregiver caring for a loved one and need help with resources and information contact LTCA of Enid Area Agency on Aging, Caregiver Coordinator, Twila Doucet at 580-234-7475.