There are several psychiatric and neurodegenerative conditions in which individuals exhibit a lack of awareness or insight that they have an illness. These people may be unable to identify their own condition accurately or understand the true extent of it. This can lead to negative outcomes like:
- Insisting they’re not ill
- Refusing treatment or medication
- Being hospitalized or re-hospitalized
- Aggressive behavior
- Early mortality
- Suicide
Anosognosia
These outcomes are seen in people diagnosed with psychiatric conditions including schizophrenia and bipolar disorder and in neurodegenerative diseases like Alzheimer’s and dementia. Anosognosia is in fact, a rather common but often underrated symptom in dementia, but after reading this article, you will see how important it is and how it can impact an individual’s quality of life.
Anosognosia is a neurological condition that impacts both individuals diagnosed with dementia and their caregivers. Some experts refer to it as a disorder of consciousness or a loss of self-awareness. It’s been estimated that up to 80% of people diagnosed with Alzheimer’s disease are affected by it.
History
Anosognosia was first described by Joseph Babinski in 1914 and he described it as a state of unawareness or impaired insight in the person’s deficits that are associated with dementia. In other words, most people with dementia don’t know they have certain problems like poor memory, reasoning, or the need for medication. They may believe they can carry on daily life as usual with no assistance or help from anyone.
What Causes It?
According to research and medical studies, anosognosia is the result of damage to the frontal lobe. This is the region of the brain responsible for planning, organizing, self-monitoring, and controlling one’s responses. This part of the brain is also responsible for a person’s ability to organize new information and update one’s self-perceptions. This means that most people with dementia don’t see themselves as having dementia.
The condition isn’t an all-or-nothing phenomenon. Some people only partially lose their ability to self-reflect and sometimes the condition comes and goes. One thing is for sure – anosognosia worsens as the disease progresses.
Common Symptoms
Individuals experiencing anosognosia will show the following symptoms:
- Impaired awareness or lack of understanding of their condition
- Denial or downplaying their illness
- Fluctuation in levels of awareness (at times will acknowledge their condition)
- Expressions of anger and frustration towards people who are aware of their illness
- Refusal of treatments or medications
Can It Be Treated?
Most experts agree that anosognosia is difficult to treat, due to the damage in the brain and the progression of the disease. Keeping the person safe and monitoring their progression is important. Since some refuse treatment or medication, they may decline faster, experience early death or attempt suicide. Some individuals will become involved in dangerous behavior such as taking unusual risks or self-medicating with various substances.
Some work has been done using vestibular stimulation, which involves attaching electrodes to the skull behind each ear or using a vestibular implant to stimulate the vestibular system. This system is responsible for enhanced cognition and balance.
Some experts report that cognitive therapy can help in the early stages before the illness becomes too advanced. Therapy would focus on trying to understand and accept one’s diagnosis and learn ways to better manage symptoms and live a quality life.
Another approach involves a form of treatment known as motivational enhancement therapy or MET for short. This is a form of talk therapy, like cognitive therapy, but is designed to focus on the many benefits of changing one’s behaviors to live with their illness.
Final Thoughts on Anosognosia and Dementia
Dementia, schizophrenia and bipolar disorder all share one common neurological condition – anosognosia, or the experience of not understanding that one has a condition and frequently refuses treatment or medication. Anosognosia eventually becomes worse as each illness progresses. While there are some therapies that might benefit the individual, maintaining a balance between safety and quality of life are always recommended.