Do former caregivers get anosognosia?

Anosognosia is due to brain pathology. Anosognosia is not denial. Once family members understand this, they can adjust their caregiving accordingly.

Iris

@elainechem

My guess is that caregivers would be as prone to anosognosia if they developed dementia for a couple of reasons.

Firstly, this is a function of the disease process and not strictly a personality trait. That said, anosognosia hits differently depending on the PWD. Dad and my older aunt were combative and uncooperative in their anosognosia— an offer of hygiene assistance was universally taken as an insult and triggered agitation. My younger aunt and my friend's mom believed they'd done things they customarily did but hadn't in some time. If an offer of a drawn bath or help with a chore was offered, they generally went along with it graciously.

Secondly, the memory losses in dementia tend to be LIFO. With understanding of anosognosia coming later in life, recognizing it would presumably be a "skill" lost fairly early in the disease I would guess.

My 86-year-old mom was dad's caregiver for at least a decade. She did eventually come to understand anosognosia in the process. Mom's always been a bit neurodivergent— she's got serious ADHD and anxiety. DH jokes that "if she developed dementia, how would we know?"

Since the start of 2024 I have developed some concerns about her memory and cognition. We're waiting on a call from the memory center to schedule having completed the preliminary blood tests and imaging.

She was positive for Lyme Disease and was treated which did seem to improve the short-term memory piece a bit, but the word finding is increasingly bad. I am increasingly the designated frontal lobe. I've also noticed some apathy, some inertia/inability to initiate tasks and trouble getting to completion of small projects. Additionally, she spends a lot of time processing her life experiences and shares unpleasant and disturbing things with me I am not always sure are true. I suspect some degree of confabulation. She seems blissfully unaware of these changes.

HB

Elaine, anosognosia is not only seen with dementia, but with other neurological conditions, such as in some stroke patients and in patients with schizophrenia, although we categorize schizophrenia as a psychiatric disorder. The presence of anosognosia may be variable, meaning a patient may be aware of having some memory or cognitive deficits, but will not be aware that the condition is a disease, that it is progressive and terminal. They are not aware that they are not functioning normally, and that they need help from another person. They just are NOT AWARE. They don't see a problem. A person in denial sees a problem, but refuses to believe that the problem is bad and causing trouble. The purpose of psychotherapy is to get the patient to develop insight into his/her problems and his/her ability to make changes.

I post a lot about anosognosia for the benefit of the caregivers, so that they can stop trying to convince their LOs that they need help. You cannot convince someone with anosognosia. It is up to the caregiver and family members to be aware and to change their approach to the PWD. Unfortunately, most people have no conception of anosognosia and spend a lot of time frustrating themselves. In your case, it would behoove you to alert your future caregivers to the reality of anosognosia, so that they could recognize it and begin using work-arounds and not frustrate themselves, or at least limit frustration. They probably won't believe you now. But perhaps you could print out and article and leave it with your instructions.

I take it your brother lives alone? You will probably have to use some of the work-arounds to get him medical attention. In the meantime, check out his environment. How is he managing his home and his finances? Is he still working? Has he had an annual performance review? You might see if he has had any warnings of poor performance. The alternative is to wait for a crisis. But you will have to be prepared for what you want to have accomplished after the crisis.

There are a lot of risk factors for dementia, some can be worked on and some cannot. I am working on what I can work on to help my brain not get worse. You might have seen my posts about my poor sleep. Poor sleep impacts cognition. This really bothers me!

Elaine, if you get a chance, you might want to read my thread about Mimi S, who was one of the original members of the boards. Her plan was to be proactive and to locate a Memory Care facility close to her child in another state, so that when the time came, the plans would already be in effect. Mimi also promoted Best Practices, and wrote about how they helped her. She was interviewed on PBS, but I cannot locate the link after the board removed the older threads. Mimi was a huge inspiration to me!

I won't go into morality. But I believe salvation is a blessing and I am glad to be saved.

Iris