Anosognosia—When People Don’t Realize They’re Impaired
The topic of anosognosia comes up regularly, particularly for people who are new here. It's confusing and confounding when your LO can't see their own impairment. I think this article is a good introduction. I hope it's helpful.
People who are experiencing dementia often refuse care. However, most of the time, it’s not due to denial or obstinacy—and you’ll exacerbate your problems if you make that assumption. Most commonly, people who are refusing help are doing so because they have become unable to be aware of their impairments. This is likely to happen when someone loses their rational thinking skills (i.e. their ability to use analysis, perceive cause and effect, or to compare what once was normal with what is now happening).
Comments
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I'm not a doctor and didn't play one on TV. Call me crazy. When I observe DH showtime in front of me, for the benefit of others that are visiting, I have a difficult time buying this explanation of 'not due to denial'. Granted, as the disease is progressing into the later stages, it is becoming more difficult for him to showtime and close friends/relatives are now seeing a small portion of the disease. Maybe PWD IS aware that something is 'off', maybe not exactly what is 'off', but 'off', none the less in denial? I guess at the end of the day it really doesn't matter.
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both things can be true. They can be unable to realize that they have an illness and yet they can showtime for short periods of time. The aftereffects of showtiming is their brain gets extremely tired and usually causes tiredness and more anxiety. You’re correct that as the disease progresses into later stages they are no longer able to showtime.
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Most of the time DW doesn't think anything is wrong, but every so often there's this flash of introspection where she says, "I don't know what's happening, there's something wrong with my brain." I don't know which is more heartbreaking, her not knowing or her recognition something is amiss.
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This was a good link. Thank you. I will definitely share with others.
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Showtiming will get harder with disease progression. He won't be as adept at it, nor will he have the mental stamina to maintain it for very long.
As for denial? What I saw with my dad was that while he would agree that he had some memory issues, a normal part of the aging process he said, and even admit that his doctor told him he had Alzheimer's, he still had anosognosia. He was unable to appreciate the degree to which his short-term memory was gone and was oblivious to any of the other losses associated with dementia— apathy, inertia, poor executive function, spatial reasoning, empathy.
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I guess my confusion evolves around the 'act' of show timing. What other purpose does the act of show timing accomplish, other than a form of denial? He only show timed for the rare visitor. He NEVER show timed for me, the 24-7 companion and I am thankful he didn't have that 'need' in front of me. I totally agree that DH is unable to realize that he has this dreadful illness, especially in these latter stages.
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I suggest thinking of showtiming not as an act of denial, but as "put your best foot forward," with family or professionals. It's not that they know they have a problem, just that they want to put in the effort to do their best at certain times, as you would in a job interview.
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I think we all showtime. If I have company, I will not be sitting in front of a TV with my hands in the front of my pants to keep them warm. If I am alone, I may be doing so - if I'm even wearing pants.
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Got it. It's basically about what we 'think' is going on. Makes a lot more sense that way, thanks!
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Commonly Used Abbreviations
DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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